Archive for the ‘health’ Category

Herbal Remedy Scam

It’s a quality control problem at best, and outright fraud at worst.

A recent study by researchers at the University of Guelph used genetic analysis to study a range of commercial herbal remedies and found a shocking disparity between what was on the label and what’s actually in the bottle.

According to the Vancouver Sun, the researchers looked at 44 herbal products sold by 12 companies, using DNA ‘barcode testing’ to determine what plant species were in the bottle.

The result: some products contained other generally inert species of plants (for example wheat, to which some people are allergic, and rice, to which some people are allergic), without those ingredients being listed on the label. Other products were adulterated with potentially toxic plants like St. John’s wort or senna. Others simply contained none of the active ingredient they were supposed to contain. And yet these products are commercially available at a major pharmacy chain near you.

The study didn’t name names — the study was effectively about quality control within the industry, rather than about naming-and-shaming particular companies. But it’s a damning indictment for the industry quite generally. (Just two companies among the 12 in the study sold products that were just what they said they were.)

Of course, many readers will know that this is not the first reason we’ve had to doubt the integrity of the herbal remedy industry, or the ‘natural’ health product industry more generally. As others have written elsewhere (including pharmacists with the scientific and critical-thinking chops to know the difference), Canada’s regulations regarding natural health products leave much to be desired.

But it’s nothing to laugh about. Unlike homeopathic remedies, which (unless adulterated) generally contain no active ingredients at all, herbal remedies can have actual effects, though those effects may not live up to the claims implied by their labels. Herbal remedies, while under-regulated, can at least have real biological effects. That’s a source of pride for makers of herbals, situated as they are within an alternative-medicine industry that is rife with outright fraud and delusion.

But it also means that the honest bottlers of herbal remedies should be at the front of the line, lobbying government hard for stricter regulations. Perhaps even more crucially they should be doing their best to convince the major chains that there’s a difference between them and the companies whose products failed the Guelph study so miserably. In the end, it’s as much an ethical matter as a matter of self-interest. The public deserves to be better served, and who better than those within the industry itself to make sure that it happens?

The Dark Side of the Tanning Business

Tanning beds are rapidly joining cigarettes in the “it’s only legal because no one has figured out how to outlaw it” category. Indeed, even their legality is slipping. Jurisdictions from Prince Edward Island to Texas, for example, are banning minors from tanning salons. Not surprisingly, dermatologists are pleased. Indeed, the Canadian Dermatology Association has issued a release, noting that indoor tanning “causes premature aging and… increases a person’s risk of developing skin cancer, including melanoma, the deadliest form of skin cancer.”

Is this a business that should exist at all? Sure, even a potentially-dangerous product can be used safely if used in suitable moderation. But the question here has to be whether moderation is the norm, and whether customers will know what moderation means.

Protecting minors is the regulatory low-hanging fruit. Protecting kids is an easy sell. Tanning beds pose a risk to anyone who uses them, but teens are in particular need of protection. Studies have suggested that younger people are more vulnerable to the harmful effects of ultra-violet radiation. And teens, in particular, tend to be both obsessed with appearance and under the sway of a general belief in their own invincibility. And According to the the dermatologists, “tanning before the age of 35 has been associated with a significant increase in the risk of melanoma.”

But beyond the case of minors, shouldn’t we all be free to tan at will? Well, yes and no. Freedom is a good thing, sure. But freedom in the marketplace is predicated on the idea that everyone involved is more or less rational and well-informed. This imposes an obligation on businesspeople to be honest and forthright about risks associated with their products. But tanning salons themselves may be promoting a number of myths that make artificial tanning seem safer than it is.

If you’re only still in business because no one has figured out how to make your product illegal, you should probably consider a new line of business.

Cream, Sugar, and Choice

Is the customer always right? Is it more important to protect consumers, or to give them options and let them choose? This is a real-life dilemma that was posed to me recently. I’ve changed the names and some other details in what follows, but the basic dilemma is real.

Abe and Ben are starting a coffee shop together. Situated in a trendy neighbourhood, the shop will feature high-quality, fair-trade, organic coffees and a range of gourmet pastries from a local bakery. They’re in the process now of deciding on their menu, and on smaller details like the condiments (sugar, cream, etc.) that will be available for patrons. It is this latter issue that has brought Abe and Ben into conflict.

Abe contends that the only condiments they should provide are cane sugar, organic milk, and soy milk. Abe wants no white sugar or artificial sweeteners. After all, he says, the health of our customers matters, and white sugar and artificial sweeteners are unhealthy.

Ben says, Look, the customer is king. Some will appreciate cane sugar, sure, but some want the white sugar they grew up with, and some diet-conscious folks will want zero-calorie artificial sweeteners, and we should give them what we want. Who are we to tell them what to do?

So who is right?

I would say choice is a good thing. To the best of my knowledge, the evidence is very weak that “other” condiments are bad for you (especially in the relevant, tiny quantities). For that matter, if Abe is that concerned about his customers’ health, he should argue for not serving sugar at all. There’s plenty of evidence that that is bad for you. As a scientist friend of mine puts it: there’s much more evidence that sugar is bad for you than there is that artificial sweetener is bad for you.

Of course, if Abe and Ben decide to make “100% natural,” or something like it, a part of their branding — as many companies do — then it makes sense to offer only condiments that are consistent with that ethos. But there’s no reason to think of that as a more ethical policy.

Obamacare and Business Values

Yesterday, the US Supreme court mostly upheld Obamacare, also known as the Patient Protection and Affordable Care Act. (See the full decision here [PDF].)

The Big Decision may have been made, but clearly lots remains to be sorted out. One of the questions that arises, from an ethical point of view, is the way that businesses, including especially insurance companies, should conduct themselves under the new plan.

Under Obamacare, Americans will be required to carry health insurance (or face a penalty) and, importantly, insurance companies will be required to sell policies to all comers, regardless of pre-existing health conditions. While the debate has focused primarily on the proper role of government, the Patient Protection and Affordable Care Act clearly has significant implications for private companies.

Note how different this is from, for example, Canada’s system. In Canada, insurance is provided by provincial health plans, and care is provided by physicians (as private contractors) and private, not-for-profit hospitals. Private insurers still play a role in pharmaceutical coverage, but almost no role at all in basic healthcare. Under Obamacare, in comparison, insurance companies effectively become an instrument of public policy: important elements of the way they conduct their business (and in particular the actuarial rules they apply) will no longer be up to them. This is far from the only example of private companies playing a role in public insurance: in the UK, private companies play a significant role in administering employment insurance services, and in some Canadian provinces private insurance brokers sell auto insurance plans underwritten by a public insurer. With regard to insurance, the distinction between private and public is far from water-tight.

How should companies conduct themselves when they play a role in delivering publicly-mandated insurance? Should they continue to think of themselves entirely as private, profit-seeking entities? Or should they — like industrial firms during times of war — take up public values?

Just what values are instantiated in a public insurance scheme is a matter of some debate. Public insurance schemes are often seen as promoting egalitarian values — ‘we’re all equal and hence all deserve equal access to basic healthcare.’ Others argue that what’s really at stake in such schemes is not equality, but efficiency (and argue that the current patchwork American system, for example, is quite inefficient in a number of ways). Others argue that, for insurance quite generally, solidarity is the key value — and one with obvious salience when insurance is part of the welfare state. Of course, to the extent that insurance companies are “merely” private corporations, they are guided by basic norms related to loyally seeking profits for shareholders. But even private insurance companies are subject to special limits on their profit-seeking. From a legal point of view, it is recognized that insurance companies are morally special: the legal principle of uberrima fides implies that the level of trust required between insurer and insured makes the relationship special, from an ethical point of view. And then, with regard to mutuals and not-for-profit insurers, stewardship of a shared resource (i.e., the insurance fund upon which members rely) is a key value. It seems right that private and public insurers would be guided by different mixes of these values.

So the question American health insurance companies face, at least in principle, is whether they should conduct themselves like private or public entities. And the question Americans face is which standard to hold them to. The answer, I think, is not clear. But it’s worth pointing out that the goals of an institution — public or private — don’t automatically have to be the goals of the larger system of which it is part. As I’ve pointed out elsewhere, the individual parts of a system don’t need to act according to the values of that system — sometimes they contribute by playing a more narrow role.

The coming years are sure to see significant changes in the US insurance industry. Whether the US government can succeed in getting private insurers to play a public-policy role remains to be seen, and depends in part on the willingness of those insurers to take up a public mission. But it depends just as much on whether the system Obama has designed is capable of harnessing the profit motive of insurance companies using it to get them to perform an important social function.

Healthcare, Unions, and Selling Donuts to Canadians

Selling donuts to Canadians sounds so easy that it seems like the punch-line to a not-very-funny joke.

Apparently, however, it isn’t always such and easy thing to do. Or at least, not easy enough to support paying double the minimum wage to the people who serve the donuts. Witness the case of the three Tim Hortons kiosks at Windsor Regional Hospital (in Windsor, Ontario, just across the border from Detroit, MI). At Windsor Regional, the donut-and-coffee kiosks are a big drain (to the tune of a quarter-million dollars a year) rather than a source of revenue. Part of the reason, apparently, is that the servers who work there are paid over $20/hour — far above Ontario’s minimum wage of $10.25. The kiosks are in effect being driven under by their own employees.

Part of the complexity of this story lies in the fact that the donut kiosks in question are at a hospital. So this isn’t just a question of a profit-hungry capitalist at odds with unionized employees. The cost overrun in this case is borne by the hospital, a not-for-profit organization that must recoup the cost in other ways.

The donut kiosks, along with other food service outlets at the hospital, are part of the organization’s overall operating budget, part of the overall cost of providing healthcare to the people in the hospital’s catchment area. As Canadian health economist Robert Evans has often pointed out, every dollar spent on healthcare is a dollar of income for someone. The result is that there are plenty of people — some wealthy, and some not so wealthy — with a vested interest in not reducing the cost of healthcare. That’s not a matter of malice; it’s just a matter of math.

But of course, the salaries of unionized employees can only be part of the tale, here. If the three kiosks have, say, two employees on duty at a time, then paying each of them only minimum wage would still only save about $120,000 — which accounts for less than half of the shortfall. So it doesn’t make sense to point to the workers’ wages as “the” cause of the problem. The supply of donuts and coffee at Windsor Regional simply seems to be out of line with demand.

Of course, one way out would be for the coffee kiosks to raise their prices. That may or may not be permitted by Tim Hortons’ franchise agreement. But anyway, raising prices would mean pushing the burden onto patients and their families along with hospital staff. And at most hospitals, the on-site food outlets have a virtual monopoly, which puts customers at a serious disadvantage. It also means that demand at a hospital is less elastic, which means the hospital kiosks have more power to raise prices than a non-hospital donut seller would. And if you believe that the wage currently being paid is a fair one (by some measure), then that’s what should be done. They should raise prices to benefit employees at the expense of patients, families, and staff.

All if this just illustrates that idealism about fair wages has its limits. In a world of limited resources — i.e., the world we live in — giving more to one person often means taking more from someone else. The result is that you can’t argue for higher (or lower) wages without talking about prices. Wages are part of an economic system, and discussions of justice in one part of that system can’t ignore justice in the others.

(Thanks to Prof. Alexei Marcoux for pointing out this story to me.)

POM Wonderful and Hearts vs Brains

The makers of POM Wonderful want you to use your heart, not your brain.

At least, that’s the distinct impression we get from the company’s recent battle with the US Federal Trade Commission. Last week, an administrative law judge for the FTC found that at least some of POM’s ads made “false and misleading” claims about the health benefits of the trendy, branded pomegranate juice. And the company is fighting back with a series of ads that, by quoting the judge out of context, makes it look like he actually looked favourably upon their product.

The tagline for these ads: “FTC v. POM: You be the judge”.

So POM wants you to be the judge. On the surface, that sounds like they want you to think for yourself. And who could complain about that? But context matters. So when the company is pushing back against the FTC’s assertion (and the court’s finding) that the health claims made on behalf of its juice just don’t stand up to scientific scrutiny, the implied message is that yes, you the consumer should decide, but you shouldn’t use your head in doing so. After all, if you used your head and thought it through rationally, you would want to look at the evidence. And, well, the evidence doesn’t look so good for POM. But the makers of POM, it seems, would rather you look inward instead of looking at the evidence. C’mon, you’ve tasted it. It’s delicious. It must be good for you. And you, dear customer, are smart enough to know that, right? Forget what the science says.

This kind of thing is arguably part of a larger social trend. See this recent essay by Joseph Heath and Andrew Potter, on the way politicians, in particular over the last decade, have found new ways to play fast-and-loose with the truth. Heath and Potter point out the new popularity of the trick of using stubborn repetition as means of bullying your way past awkward facts. A lie can be convincing, in particular when it feels right, when the claim being made fits with your world view or how you want the world to be. And who wouldn’t like to believe that a tasty serving of fruit juice could prevent heart disease or cancer?

The makers of POM are certainly not unique among advertisers wanting you to use your heart, rather than your brain. But they are unusually bold about it, going on the offensive and thumbing their noses at the people whose job it is to do the fact-checking. So consumers beware: when a company wants you not to take a hard look at the facts, it’s usually time to do just that.

Meatless Monday and Social Responsibility

Meat has recently taken on the role of the culinary bad boy, the gustatory rebel without a cause. Meat is the leather-wearing trouble-maker that scoffs at moral authority, making some people tsk-tsk and making others swoon.

Witness the fact that, couple of weeks ago, the New York Times announced a contest, asking entrants to provide their best argument as to why eating meat is ethical. In other words, the idea is to provide a rebuttal to what is by now nearly the default position, which is that meat is ethically problematic. And it’s not hard to see why. Even if you aren’t convinced that contributing to vast animal suffering is unethical, there are the very significant environmental impacts to consider. And when meat is thought of as a product that you either sell to consumers or feed to your children, health impact certainly becomes part of the ethical equation: how much beef you consume is between you and your colon, but how much you foist on others is open to scrutiny. So if meat If meat isn’t outright unethical, it’s certainly not the most socially-responsible product I can think of.

So, given the current ethical presumption against meat, do food companies that see themselves as socially responsible have a responsibility to minimize, or at least reduce, the amount of meat they sell?

In that regard, see this interesting report about how one company — Sodexo — worked to reduce the amount of meat eaten by its customers. The company runs cafeterias at hospitals and government buildings and so on, and serves over 9 million meals each day. And about a year ago, Sodexo announced that it would participate in the “Meatless Monday” program, urging customers to eliminate or reduce the amount of meat consumed just one relatively painless day each week.

The result is an absolutely perfect case study in the debate over corporate social responsibility.

The Sodexo experiment starts off as nothing less than a best-case scenario of CSR. Sodexo, in introducing Meatless Monday in its cafeterias, was arguably pursuing a win-win strategy. Serving less meat is good for the environment, good for consumers’ health, and (since meat is an expensive ingredient) maybe good for the bottom line. As an experiment, at least, it’s not crazy from a business point of view. So Meatless Monday presented the possibility of social benefit without pain: the holy grail of CSR.

Notice also the lack of sanctimony here. There’s nothing preachy about Meatless Monday: it’s just a way of saying hey, there are some really simple, painless steps that all of us can take to make the world a slightly better place.

But wait: it’s too soon to celebrate. It turns out that among Sodexo’s participating cafeterias, almost a third saw a drop in sales, and some saw a drop in customer satisfaction ratings. So much for the win-win! In the face of a significant drop in sales, a corporation’s managers face a true ethical dilemma, torn between social responsibility and responsibility to vulnerable shareholders. Should the company’s managers stick with Meatless Monday — ostensibly the socially responsible choice — or give it up and bring sales back to their previous level? Which matters more, social benefit or profits? Or, more precisely, how much would sales have to drop in order plausibly to say that the company was taking social responsibility too far?

A case like this strikes me as a pretty good litmus test with regard to divergent views on corporate social responsibility. It’s easy to be in favour of the win-win stuff. If a company can boost profits while doing some good in the world, who could complain? And if you can help others (or society) at no cost to yourself, maybe you’re even obligated to. But fewer people, I suspect, are willing to argue for a corporate obligation to engage in socially beneficial behaviours that not only hurt profits but also reduce customer satisfaction.

The next step in the litmus test, of course, is to adjust the ethical inputs, namely the strength of the ethical ethical arguments against meat. If you’re generally supportive of Sodexo’s move, how much weaker would the arguments against meat have to be in order to change your mind? And if instead you think Sodexo’s experiment is unjustified, how much stronger would the case against meat have to be to convince you that a company is justified in at least attempting to pursue socially-good objectives through its business practices? Answering such questions is a crucial step towards understanding your own point of view, and hence to being better prepared to engage in thoughtful discussion of corporate social responsibility.

McDonald’s and the Ethics of Olympic Sponsorship

McDonald’s has been taking some heat over its continuing sponsorship of the Olympics. The fast-food chain recently announced that it would remain a top sponsor of the Olympic games through 2020.

The main charge here seems to be some form of hypocrisy. Critics suppose that there’s some sort of contradiction involved in a sporting event being sponsored by a fast-food chain. But there is, of course, no contradiction at all — at least not for those of use who take both our sports and our junk food in moderation. True, a diet that includes frequent trips to McDonald’s (or Burger King or Wendy’s, etc. etc.) seems inconsistent with a lifestyle aimed at maximal athletic output. There’s a real conflict there. But few of us are aiming at elite sporting status, and relatively few of us (thankfully) make Big Macs a staple. Most of us enjoy both sport and junk food in moderation. For us, the occasional serving of greasy fries does absolutely no harm at all to our athletic aspirations. There’s no contradiction in loving, say, both a Quarter Pounder With Cheese and training for a Half Marathon. So there’s no inherent contradiction involved in McD’s sponsoring the Olympics.

And really, if anyone is to blame, it’s not McDonald’s but the International Olympic Committee, and/or whatever subcommittees or functionaries are assigned the task of signing sponsors. After all, it’s their supposed values, not the fast-food chain’s, that this sponsorship deal presumably violates.

But supposed value-conflicts aside: what about the effect of such the McDonalds/Olympics alliance on, for example, kids? Well, note to start that kids don’t watch the olympics much. As for the rest of us, well we need to come to grips with the fact that our economic system features certain warts. And one of those warts is that the freedom to buy-and-sell means the freedom to sell things the over-consumption of which is harmful. And the freedom to sell such things implies the freedom to advertise them. Is affiliation with McDonald’s jeopardizing the positive impact of the Olympics? So be it. Our system of free commerce is a system that brings with it enormous benefits, far more benefits than will ever be derived from one hypertrophied sporting event.

Ethical Complexity and Simplification in Food Choices

As I pointed out a few days ago, shopping ethically is hard. Right on cue, a flurry of news items followed to drive that point home.

First, a story about how — say it ain’t so! — local food isn’t always ethical food. The story points out that some agricultural workers in southern Ontario (just a short drive from where I live) report suffering from a range of ailments that they attribute to the chemicals to which they are exposed. So, yes, there’s more than a single dimension to food ethics. If (or rather when) local is actually better, that’s got to be an “other things being equal” sort of judgment. Local might be better — so long as local farm workers aren’t being abused, and so long as growing food in your local climate doesn’t require massive water and fuel subsidies, etc.

Next, a Valentine’s-themed bit on how to buy ethical chocolate. The short version: apparently you’re supposed to look for local, organic chocolate that’s certified free of child-labour, sold in a shop that dutifully recycles and composts. Of course, such chocolate isn’t necessarily cheap. And if you’re spending that much on chocolate, then you might want to think what other things you’re scrimping on as a result, and who might be affected by that scrimping.

Finally, there was a story — really just a press release — noting that chocolate bar manufacturer Mars is set to ‘help’ consumers by narrowing their choices: the company is aiming to put a 250-calorie limit on all its bars by 2013. Interesting question: is this a matter of helping particular customers, by encouraging them not to over-indulge? Or is it rather a matter of specifically social responsibility, an attempt by a food giant to respond to (or at least to limit its contribution to) the social problem of obesity? And — speaking of value choices — should food companies aim first and foremost at pleasing their customers, or serving society as a whole?

Stem Cell Fraud

Stem cell science is pretty sexy. And as the saying goes, “sex sells.” And if something sells, someone is liable to make a buck off it, whether it’s right to do so or not.

See this opinion piece (in The Scientist) by Zubin Master and David B. Resnik: Reforming Stem Cell Tourism.

As with many new areas of technological advancements, stem cell research has received its fair share of hype. Though much of the excitement is warranted, and the potential of stem cells promising, many have used that hype for their own monetary gain. … Young and elderly patients have died from receiving illegitimate stem cell treatments; others have developed tumors following stem cell transplantations….

Master and Resnik point to the need for patient education, and to the limits of international guidelines, but their main focus is on the ethical responsibilities of scientists — including the responsibility not to cooperate in various indirect ways with unscrupulous colleagues. (It is very, very hard to do clinical science in a vacuum, and so isolating unscrupulous scientists may be one way to put them out of business.)

But it’s important to point out that this is as much a story of business ethics as it is of scientific ethics. The unscrupulous individuals preying upon the sick aren’t doing it for free. What these clinics are doing is committing fraud, and endangering their customers in the process.

Now there’s nothing ethically subtle about that. You don’t need a Ph.D. in philosophy to know that fraud is bad. But there’s another, subtler, issue here, namely an underlying theme about the general lack of scientific literacy on the part of consumers and the ability of business to use it to their advantage. Companies of all kinds can do a lot of good in the world by promoting scientific literacy, and by being scrupulously careful about having the facts straight when they present their products to consumers and tell them, “this works.”

Now of course, we’re never going to prevent such behaviour entirely. As long as there are desperate people in the world, there will be snake-oil salesmen eager to make a buck from their misery. But as Master and Resnik suggest, that doesn’t mean we shouldn’t try.

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