Login
I just submitted a letter opposing the so-called California Journalism Preservation Act that is now going through the Senate. Here’s what I said (I’ll skip the opening paragraph with my journalistic bona fides):
Like other well-intentioned media regulation, the CJPA will result in a raft of unintended and damaging consequences. I fear it will support the bottom lines of the rapacious hedge funds and billionaires who are milking California’s once-great newspapers for cash flow without concern for the information needs of California’s communities. I have seen that first-hand, for I was once a member of the digital advisory board for Alden Capital’s Digital First, owner of the Bay Area News Group. For them, any income from any source is fungible and I doubt any money from CJPA will go to actually strengthening journalism.
The best hope for local journalism is not the old newspaper industry and its lobbyists who seek protectionism. It will come instead from startups, some not-for-profit, some tiny, that serve local communities. These are the kinds of journalists we teach in the Entrepreneurial Journalism program I started at my school. These entrepreneurial journalists will not benefit from CJPA and their ventures could be locked out by this nonmarket intervention favoring incumbent competitors. From a policy perspective, I would like to see how California could encourage new competition, not stifle it. I concur with the April letter from LION publishers.
More important, the CJPA and other legislation like it violates the First Amendment and breaks the internet. Links are speech. Editorial choice is speech. No publisher, no platform, no one should be forced to link or not link to content — especially the kinds of extremist content that is ruining American democracy and that could benefit from the CJPA by giving them an opening to force platforms to carry their noxious speech.
Note well that the objects of this legislation, Facebook and Google, would be well within their rights to stop promoting news if forced to pay for the privilege of linking to it. When Spain passed its link tax, Google News pulled out of the country and both publishers and citizens suffered for years as a result. Meta has just announced that it will pull news off its platforms in Canada as a result of its Bill C-18. News is frankly of little value to the platforms. Facebook has said that less than four percent of its content relates to news, Google not much more. Neither makes money from news.
The CJPA could accomplish precisely the opposite of its goal by assuring that less news gets to Californians than today. The just-released Digital News Report from the Reuters Institute for the Study of Journalism at Oxford makes clear that more than ever, citizens start their news journeys not with news brands but end up there via social media and search:
Across markets, only around a fifth of respondents (22%) now say they prefer to start their news journeys with a website or app — that’s down 10 percentage points since 2018…. Younger groups everywhere are showing a weaker connection with news brands’ own websites and apps than previous cohorts — preferring to access news via side-door routes such as social media, search, or mobile aggregators.
Tremendous value accrues to publishers from platforms’ links. By lobbying against the internet platforms that benefit them, news publishers are cutting off their noses to spite their faces, and this legislation hands them the knife.
In a prescient 1998 paper from Santa Monica’s RAND Corporation, “The Information Age and the Printing Press: Looking Backward to See Ahead,” James Dewar argued persuasively for “a) keeping the Internet unregulated, and b) taking a much more experimental approach to information policy. Societies who regulated the printing press suffered and continue to suffer today in comparison with those who didn’t.” In my new book, The Gutenberg Parenthesis, I agree with his conclusion.
I fear that California, its media industry, its journalists, its communities, and its citizens will suffer with the passage of the CJPA.
The post California’s protectionist legislation appeared first on BuzzMachine.
By Leo Lam and Taylor Nichols.
The COVID-19 pandemic has greatly disrupted the operation of our society. To cope with a novel virus to which humans had no immunity, public health authorities took a multitude of actions such as lockdowns, mandates on non-pharmaceutical interventions such as masks, and later on vaccines in specific circumstances to protect the population. Naturally, whenever mandatory actions are enforced, ethical questions regarding liberty and the question of choice arise and the answers are not always clear.
One way to help guide us through such an ethical dilemma is to perform a risk and benefit analysis on the individuals and the community affected by these actions. This is also not a simple task as some risks/benefits may be superficially qualitative and as such, quantitative comparisons must be formulated carefully to avoid bias and therefore skewing the outcome of the analysis. Ethical positions must be informed by scientifically justifiable facts, not cherry-picked values that support preconceived notions.
In another word, the risk profiles for the risk and benefit must be closely matched for the analysis to be fair, defensible, and scientifically justifiable. Without this consideration, merely comparing numbers may create an illusion that sways the argument one way or the other, while the actions that optimally benefit society and individuals languish in the noise.
Vaccine mandates, especially those that apply to college campuses, have been a point of contention among experts and general society because the risk and benefit analysis is not as clear cut for the college-aged population as, for example, those who are over 65. The college-aged group does not get as sick when infected, and the death rate is lower. Yet regardless of age, some risks do exist and such risks must be carefully balanced against the perceived lowering benefit as we progress down the age groups.
To perform a robust analysis for this younger age group, details matter when it comes to examining the risk profiles. On the benefit side for this age group in decreasing severity, vaccines reduce the number of deaths, reduce the number of cases of severe diseases that require resource-intensive hospitalizations, reduce the overall number of cases, and lower the chance of Long COVID even for mild cases. Each one of these benefits reflects different levels of resource consumption for treatments and individual suffering with long-term and short-term implications. It is also clear that there are public health benefits that affect other age groups when this group is vaccinated. On the negative side, receiving the vaccines comes with risks such as Severe Adverse Events (SAEs), reactogenicity, and myocarditis, especially for the males in the group. Each one of these risks also requires the consumption of resources to treat and represent varying levels of personal suffering.
For example, using the number of cases to quantify the risk of SAEs seems straightforward, but the severity of such SAEs would determine which benefits should be compared. The SAEs reported in the Pfizer vaccine trial were “moderate persistent tachycardia, moderate transient elevated hepatic enzymes, and mild elevated hepatic enzymes” all of which were reported to be transient, self-resolved events that did not require hospitalization in the trial. It would be, therefore, inappropriate to compare this low level of severity to death or even to hospitalized cases of COVID given the differential in treatment resources and suffering. While still imperfect, it would be more reasonable to compare it to the number of COVID cases prevented. There is a spectrum of severity in COVID cases, some resources are still needed to treat on average, and with Long COVID being a non-insignificant possible outcome, the risk profile of a COVID case is still higher than the reported SAEs. Here, the precautionary principle applies, and erring on underestimating the benefits is not unreasonable to prevent harm.
Our paper that examines the ethics of college vaccine mandates uses the same process to identify the correct comparison pairs for SAEs, reactogenicity, and the chance of myocarditis. It can be demonstrated that the resources saved via vaccine mandates far exceed the resources needed to treat the risks and that the population in that age group benefits from vaccination far more than the risk they are exposed to from vaccination when risk profiles on both sides are carefully balanced. Attending college is also a privilege, not a right. We concluded that the vaccine mandates carry more benefits than risks on both an individual level and on a societal scale on quantifiable grounds. And thus, college mandates are ethical.
Paper title: The ethics of college vaccine mandates, using reasonable comparisons
Authors: Leo Lam, Taylor Nichols
Affiliations: University of Washington, University of San Francisco
Competing interests: None
Social media accounts of post authors: @SeattleiteLeo @tnicholsmd
The post College vaccine mandates benefitted students and society appeared first on Journal of Medical Ethics blog.
By Karel-Bart Celie.
In a recent issue of JAMA, Ahmed et al. published data on healthcare unionization in the United States between 2009 and 2021. Despite the observed association between unionization and higher wages, better benefits, and more equitable compensation, unionization among healthcare workers has evidently remained low. Richman and Schulman (R&S) wrote a commentary focused specifically on unionization by physicians. They argued that physician unionization helps (1) restore some governance of healthcare systems and (2) provide a mechanism by which to deploy professional ethics in the service of patient welfare.
To the first point, more than half of all U.S. physicians are now employed by hospitals or other health systems. This shift in the landscape has resulted in a decrease in “professional sovereignty” threatening the loss of professional independence—something unionization might help prevent. Regarding the second point, leaders of large health systems have at best a divided loyalty; they are obligated to prioritize the fiscal concerns of their institutions. For example, one way to maximize profits is to minimize staffing despite a burned-out workforce and evidence that such practices can lead to worse outcomes. Physicians, on the other hand, have less of a commitment to the financial bottom line of the institution. And in any case, deeply-ingrained professional ethics serve as a corrective that “counters market incentives.” Unionization provides physicians with a “means to exert influence” on large health systems, in a manner that reflects the profession’s dedication to patient welfare.
I agree with these points and would like to submit two additional observations.
First, the age-old call to “at least do no harm” cited by R&S, which appears in Book I of the Epidemics, is often interpreted in relation to patient care. However, there is also a contextual argument for a similar duty to colleagues in the Hippocratic corpus. The Hippocratic Oath devotes a sizeable second paragraph to describing the respect and care with which one should treat one’s teachers and pupils. This paragraph accounts for nearly a third of the total text, and exhorts its reader to regard both teachers and pupils as family. It serves to remind us that our duties are not only to patients, but to each other as well. This is an aspect that is under-emphasized, to the detriment of a profession that is so inexorably collegial. How we consult with physicians from other specialties, with nurses and other allied staff, and with those who are learning from and teaching us, all have an impact on “the profession” and how its values are applied. The doctor-patient relationship—recipient of much attention—exists only in the context of physicians who constantly learn from, teach, and interact with each other.
The communal aspect of our professional ethics is obliquely understood, for example, when reporting unprofessional conduct. However, we do not have to stop at the negative. Physicians are accountable to each other in a positive sense also. Unionization is one way of giving this positive, intra-professional obligation a voice. It does so by promoting an environment of mutual support, collegiality, and legitimate concern for the wellbeing of members of the profession.
Second, housestaff unionization merits special attention at a time when burnout and depression remain prevalent among trainees in medicine. Unions help ensure fair wages and benefits; at my institution, wages for first-year doctors have risen by 15% since 2020. The accrediting body for graduate medical education (the ACGME) in the U.S. has increased initiatives to improve wellness in graduate medical education since 2017. However, it wields its punitive power over residency programs which are often themselves under pressure of the demands put upon it by institutions. Residents and their teaching faculty are often together in the proverbial “trenches.” Complaints to the ACGME are therefore challenging and often last-resort options for help, since everyone knows that doing so may simply shift the burden to another demographic (e.g., by removing trainees from a rotation, the same patient volume falls on the remaining faculty). Take for example the rule—a definite step in the right direction—that trainees are to work no more than 80 hours per week (caveat: averaged over 4 weeks!). Environments with low levels of staffing and high patient volumes virtually guarantee unacceptably high housestaff work hours. How could it not, especially where patient care is prioritized? Unions by contrast are more capable of addressing root causes, such as low levels of staffing, by directly confronting institutional stakeholders without necessarily compromising patient care. They also have the potential to spur legislation which holds institutions accountable for the treatment of their staff.
It is also important to note that housestaff unions can have a direct impact on improved patient care. The Patient Care Fund (PCF) was established by the Committee for Interns and Residents (CIR) in Los Angeles County in 1975 as a funding mechanism for trainee-driven improvements in patient care equipment. Since then, similar funds have been established by CIR across the country. In the last three years, housestaff from my own division have acquired a combined pulsed dye laser (PDL) and neodymium yttrium aluminum garnet (Nd:YAG) laser for burn reconstruction, as well as a new microscope for free flap reconstruction and digital replantation. All together this equipment represents nearly $300,000 invested in patient care at one of the busiest county hospitals in the country.
In summary, unionization by physicians in the U.S. provides a mechanism for us to apply our professional ethics, and thereby honor our (underemphasized) duties to each other. As a surgical trainee, I have also found that unions hold the potential to provide a more direct path to housestaff wellness than those currently afforded by educational organizations. For these reasons physician unionization merits continued support, despite the low rates reported by Ahmed et al.
Author: Karel-Bart Celie
Affiliations:
Competing Interests: None declared
Social media accounts of post author: Instagram @celie.md
The post Housestaff unionization in the United States and our duties to each other appeared first on Journal of Medical Ethics blog.
In January 2021, after a sleepover with her best friend, 12-year-old Molly Steinsapir got onto an e-bike in her Los Angeles neighborhood, crashed, and died. Who was responsible for the tragedy? Molly’s parents have sued Rad Power Bikes, a popular e-bike manufacturer. Author Peter Flax examines the thorny legal questions at the heart of the lawsuit and illuminates the potential pitfalls of the e-bike industry’s explosive, largely unregulated growth, in part by speaking with other Rad Power Bike users who, like Flax, have experienced worrying equipment problems:
I started talking to my neighbors. During the pandemic, hundreds of teenagers in my community took to the streets on RadRunners and other inexpensive DTC e-bikes with mechanical disc brakes, and I discovered that many of them were having similar issues. Some parents were clued into the problem and were either scheduling regular maintenance with local shops or learning how to make the fixes at home, while others had no idea that their kids were riding heavy electric bikes that couldn’t stop properly without frequent maintenance. I started a thread on Nextdoor with a summary of the problem and how to address it, and soon I was DMing with parents who wanted tips on barrel and caliper adjustments.
One of my neighbors — his name is Ezra Holland and he lives about five blocks from me — says that almost immediately he started noticing disturbing braking issues with the RadRunner he purchased early in 2022. Two or three weeks after he got it, Holland, an experienced road cyclist, noticed that the responsiveness of the brakes was poor, and he decided to remedy the problem by tightening the cables that run from the levers to the calipers. But he learned that this only bought him a few weeks, and that after tightening those cables a few times, one of the calipers clicked into a different position where there was zero braking action. “That is pretty scary,” he says.
Thus began a year of education, vigilance, maintenance, and communication with Rad. Holland now buys pads in bulk on Amazon; he checks and adjusts both calipers every two weeks, always on alert for a failure. He’s experienced the rear brake fail going downhill and is especially concerned about that happening while his 17-year-old is using the bike. Rad has sent him new brakes and new pads, but Holland says that in his ongoing phone calls with the brand, customer service reps and supervisors have told him that other customers aren’t experiencing braking issues like he has. But he alone knows a half dozen friends and neighbors struggling with the same problems. “I just got to a point where I started questioning my own thinking, because they keep saying I’m wrong,” he says. “I start thinking that maybe I’m just making a fuss here for no reason. Which I think is not fair, because I think it’s not true.”
FreshRSS