Thursday, April 29, 2010

Could We Please Stop Talking about "Clean Coal"?

... or "cheap coal" for that matter.

The fact is, it's neither clean nor cheap.

Coal-fired electric power plants might look like a cheap way to produce energy, but only if you concentrate on how much a ton of coal will cost you on the open market today (for what it's worth: as of last week, according to Energy Information Administration, the highest Btu coal, from Northern Appalachia, would run you $62.75).

Make no mistake, there's no way to make that power clean, however.

And when you count more than just the market -- don't get me started on the impact of mountain-top removal -- coal's not cheap, either.

As if the disaster at the Massey Energy's Upper Big Branch mine in West Virginia on 6 April wasn't enough, there's now word that two miners are missing following a roof collapse at Alliance Resource Partners' Dotiki Mine in Kentucky (read news reports from the Associated Press here and from Bloomberg here).

The Upper Big Branch catastrophe killed 29 miners, the worst US mining disaster in four decades. And now two more men won't be coming home.

Does that sound "cheap" to you?

Business Week has an excellent analysis up on the sorry state of regulation, at least as far as protecting miners is concerned. The 2006 Mine Improvement and New Emergency Response Act (The MINER Act -- get it? Oy. I hate cutesy acronyms.) came in the wake of another catastrophic West Virginia mine disaster, at the Sago Tmine in which 12 miners were killed.

According to the article: "The act raised the maximum penalty for safety violations, forced mine operators to build emergency underground shelters with oxygen, water and food, and required installation of more modern communication devices." That all sounds good, doesn't it?

Let's take a closer look.

The Dotiki mine, according to news reports, was ranked seventh in the number of "significant and substantial" violations since 2009 (for data junkies, the website of the Mine Safety and Health Adminstration is a great resource). A "significant and substantial" violation means that the MSHA inspector considers that "there exists a reasonable likelihood the hazard contributed to will result in an injury or illness of a reasonably serious nature" (click here for full MSHA document).

Why would a mine that has such a record be operating?

As Business Week's Jeff Plungis and Holly Rosenkrantz report, "While the new law did result in more citations and higher fines, the Labor Department's Mine Safety and Health Administration in 2007 added 10 criteria that inspectors had to meet before a mine could be shut down for a 'pattern of violations'... Only one mine has ever been ordered closed for a pattern of violations... That order, issued in November 2008 to a Patriot Mining LLC mine in Virginia, was revoked when one of the violation findings was withdrawn..."

Does that sound "clean" to you?

So miners keep getting injured and dying, and fines have come to be seen as a cost of doing business. And we don't really notice until there's a major disaster, like Upper Big Branch (the Dotiki roof-fall is not leading most of today's news reports).

Meanwhile, by challenging citations (there's a helpful link right on MSHA's home page: "How to contest citations"), the industry pushes off the date when penalties might have to be paid.

According to Business Week, the "backlog of challenged cases ... has grown to more than 16,000 today from fewer than 1,500 in 2005" (emphasis added).

The current regulations don't even have baby-teeth; all they can do is gum a violator. It's time to stop pretending that miners' lives are valuable, and time to start acting as though we really believed that. A respectful minute of silence is good; tough legislation would be much better.

Thursday, April 22, 2010

How "Informed" Should "Informed Consent" Be?

As informed as you can possibly make it, of course.

I've been thinking about "informed consent" a lot lately, ever since I read the first articles and reviews about "The Immortal Life of Henrietta Lacks". Rebecca Skloot's nonfiction account of the culturing of cervical cancer cells taken from Lacks -- without her permission -- in 1951 is transfixing. (New York Times book reviews are here and here; a "health" section article is here)

Skloot's book reminds us just how recent some concerns about informed consent are. Henrietta Lacks died in Johns Hopkins Hospital's "colored ward"; she and her family were never asked about the research use of her cells, nor were they ever compensated financially (as reviewer Lisa Margonelli noted, "HeLa [as the cells are known, from the first two letters of Lacks' first and last names] has helped build thousands of careers, not to mention more than 60,000 scientific studies, with nearly 10 more being published every day...").

Skloot's book (quoting Margonelli again) criticizes "science that insists on ignoring the messy human provenance of its materials. 'Scientists don't like to think of HeLa cells as being little bits of Henrietta because it's much easier to do science when you dissociate your materials from the people they come from,' a researcher named Robert Stevenson tells Skloot in one of the many ethical discussions seeded throughout the book."

We like to think things have changed since the early '50s. Not only would Ms. Lacks no longer have been required to stay in the hospital's "colored ward", but we would certainly ask her permission today. Anyone who has been treated for almost anything these days is familiar with the "sign here" routine of consent forms.

But how much have things really changed?

Today's Times carries an article by Amy Harmon on the payment of $700,000 by Arizona State University to members of the Havasupai tribe in settlement of complaints about the misuse of tribal members' blood samples. The university will also return blood samples and provide other forms of assistance to the tribe.

According to the article, members of the Havasupai tribe provided blood samples to university researchers in 1990, "in the hope that they might provide genetic clues to the tribe's devastating rate of diabetes." A broad consent form was prepared, and donors signed that form. Later, the tribal members learned that the blood samples had been used to study for genetic variants that would be linked to diabetes, but also for schizophrenia, metabolic disorders, alcoholism, and more. Studies were published reporting "a high degree of inbreeding" and that "the tribe's ancestors had crossed the frozen Bering Sea to arrive in North America", and more.

All of it interesting research, no doubt, and some of it valuable, but all of it unethical.

The geneticist responsible for the original studies, Dr. Therese Markow, now a professor at the University of California, San Diego, insisted that she was "doing good science", and that those who have complained "failed to understand the fundamental nature of genetic research, where progress often occurs from studies that do not appear to bear directly on a particular disease."

The consent forms were purposely broad, Dr. Markow said, because "English was a second language for many Havasupai, and few of the tribe's 650 members had graduated from high school. They were always given the opportunity to ask questions, she said, and students were also instructed to explain the project and get written and verbal consent from donors."

Should I list all the things that are wrong with the previous paragraph? Well, for starters:
  • If you are genuinely concerned about the English-language skills of your prospective donors, how about having the forms translated into their native language, or at the very least providing skilled translators?
  • If you're planning on using the samples for more than one test, tell the prospective donors. Maybe you don't know where the research might take you. Tell them that, too.
  • Is the Havasupai culture one that encourages asking questions of people perceived to hold power or not? If not, you could ask, "Do you have any questions?" until the cows come home, and never hear any. That wouldn't mean that there were no questions.
It was only by sheer accident that the misuse of Havasupai blood samples was discovered, according to the Times article. One tribe member, who had attended college, was visiting at the University and was invited to a student's doctoral presentation. The research on which that dissertation was based was derived from research with the Havasupai DNA. The tribal member "understood little of the technical aspect, but what she heard bore no resemblance to the diabetes research she had pictured when she had given her own blood sample years earlier."

During the post-presentation question period, she asked whether he had permission to use the donated tribal blood for this purpose.

"The presentation was halted. Dr. Markow and the other members of the doctoral committee asked the student to redact that chapter from his dissertation."

Could anything be more damning?

But it's not just cultural and language barriers that all too often make "informed consent" anything but. There's also timing.

When a friend underwent surgery a few years ago, just before being wheeled into the operating room, already hospital-gowned and mentally prepared, he was handed a clipboard and pen to sign the "consent form" permitting the surgeon to use tissue removed in the operation for research purposes.

If he hadn't signed, the operation wouldn't have gone forward. So of course he did. But let's not pretend that his experience was "informed consent."

Research needs to be done. But not by trampling over the human subjects who make that research possible. Even if it's just in the name of "efficiency".

Wednesday, April 14, 2010

Raise My Taxes, Please!

I'll be the first to admit that 2009 was not a great year, incomewise. But -- on the optimistic assumption that 2010 will be better -- I want to be on record, the day before Tax Day, saying, Raise my taxes, please.

In this, happily, I'm not alone.

NPR ran a nice piece on Morning Edition today (click here for print version; audio is here) on "some of the rich ask for higher taxes." Among the people quoted is Jeffrey Hollander, a co-founder of Seventh Generation eco-products, who says that so-called trickle-down economics is "really about keeping money in the pockets of people who already have too much money."

Hollander and others are members of the Responsible Wealth Project of United for a Fair Economy, which (to quote their website), holds that "concentrated wealth and power undermine the economy, corrupt democracy, deepen the racial divide, and tear communities apart."


In fact, that position makes so much sense to me, I have to stop and ask -- why on earth isn't every American a member of United for a Fair Economy?

I blame the "bootstraps" myth -- the idea that any American can, purely by his or her own effort, rise from the deepest poverty to the greatest wealth.

It's a great story, but it's a myth.

In fact, it's the most dangerous myth I know.

No one does it alone. Not only are there innumerable people who propelled Joe Bootstraps on his way (whom he is now conveniently forgetting -- hello, Mom and Dad? Third-grade teacher Mrs. Benton? Boy Scout leader Mr. O'Hanlon? Rabbi Shlomo Ereritz? High-school science teacher Mr. Yee? You get the idea.), there are also innumerable institutions of law and government that made it possible for Joe to succeed.

Would Joe have succeeded without the trust that's embedded in a working economy grounded in the rule of law?

His first customers could be confident that if he were merely a flimflam artist, sooner or later regulators would find him out and he would be prosecuted and at least a portion of their lost funds would be returned.

His first employees could be confident that, were his interview promises to prove false, there was some legal recourse to which they could turn.

His first suppliers could be confident that, should Joe neglect to pay them promptly, they too had legal recourse.

You get the idea.

I try to keep good company, so I'm with Oliver Wendell Holmes Jr. on this: "Taxes are the price we pay for civilization."

I want more civilization, so go ahead, Tax me more.

Saturday, April 3, 2010

You Wouldn't Buy a Car Without a Warranty; How About a Hip?

Let's say I'm a car manufacturer, and a prospective customer is asking about what sort of warranty I'll be offering on my new XY7200. Here's my reply:

"The longevity of a vehicle depends on a great many factors beyond my control, including the driver's skill, the types of driving done, and the owner's adherence to break-in time restrictions and the regular maintenance schedule. Because of the multifactorial nature of the survival of a vehicle, no, we really can't offer any kind of warranty."

So... would you buy that spiffy new XY7200?

I didn't think so.

I wouldn't either.

Such a scenario could never play out in the big-ticket world of automobiles, or in the small-ticket world of appliances like toaster, TVs, and kitchen mixers.

But in orthopedic implants? Oh, yeah.

Today's New York Times has an excellent article by Barry Meier on how the "health system bears [the] cost of implants with no warranties."
The million or so artificial hips and knees implanted each year in the United States ... are normally not guaranteed. Instead, the costs of replacing implants that fail early because of design or mechanical problems -- devices that sell for as much as $15,000 each -- are largely paid by Medicare, insurance companies and patients.
Implants can fail for many reasons, but if only a small percentage of them fail prematurely because they are substandard, the costs to taxpayers, policyholders and patients can run into tens of millions of dollars each year, health care experts estimate.

Orthopedic producers may sometimes even profit from the failures because they sell the replacements at full price.
Anyone else see a problem with this picture? [Read the full article for, among other things, the comment by Zimmer Holdings on why they don't guarantee their products, which I only barely parodied above.]

There are serious financial concerns here -- at a time when everyone is arguing about how best to rein in healthcare costs, this seems like a good place to start -- but there are also serious ethical concerns.

The system, as currently constructed, actually provides incentives for building something badly. Why should I care if my products are substandard if I don't have to bear the cost? If, indeed, there is a financial incentive to do so? (Yes, I know, we'd like manufacturers to build good products because it's the right thing to do....)

To add insult to injury, accord to Meier's piece, at least one manufacturer does offer warranties on certain of its knee, hip, and shoulder implants (including a "free of charge replacement" if one fails) ... just in Great Britain, and not in the United States.

Friday, April 2, 2010

Is Pay Garnishment More Immoral Than Debt?

"We are confident we are treating our customers fairly and with integrity," says an HSBC North America spokesman in today's New York Times article (by John Collins Rudolf) about garnishing the pay of consumers who owe the bank for credit-card or other personal loan debt.

The spokesman's definition of "fairly and with integrity" appears to be slightly different from mine.

In the specific case reported, a 45-year-old Virginia maintenance worker took out a $4097 personal loan in 2001 from a subprime lender now owned by HSBC. He fell behind on the payments, and was taken to court. Since he failed to appear ("I just thought they were going to take what I owed," he is quoted as saying), the lender was awarded a judgment of more than $5500 (including lawyers' fees), with debt to accrue at 27.55% until paid in full. By 2003, the bank was garnishing his wages, and continued to do so over the next six years, deducting more than $10,000 from his earnings ... and the end of which he still owed the company nearly $4,000, "a sum," Rudolf notes in the article, "nearly equal to the original loan amount."

"Dale Pittman, a consumer law lawyer in Petersburg, Va., took ... [this] case without charge, and found that all but $134 of his [client's] payments had gone toward interest, fees and court costs. 'It's a perfectly legal result under Virginia law,' Mr. Pittman said."

Does this really sound like treating a customer "fairly and with integrity"? To me, it sounds more like "usury" or even "loan-sharking".

I'm not suggesting that Mr. Pittman's client's debt should have been forgiven as soon as he fell behind. Fiscal responsibility is important; most of us struggle, but manage, to owe no more than we can afford to pay. But it's also important to recognize, and allow for, the power differential in the lender / borrower relationship, and especially to recognize that circumstances can change fast.

In the current Great Recession, there are millions of people falling behind on credit-card bills, mortgage payments, home-equity loans, and other bills, not because of some terrible moral failing on their part, but because it had never occurred to them that they could be out of work for so long, or that their homes' values could have fallen so far. The bank's first step should have been to find out why Mr. Pittman's client had fallen behind on his payments -- did he have an accident that kept him from working for a week or a month? did a child become severely ill? did he underestimate the size of his income-tax refund? did he play the ponies with money that was supposed to have gone to bank payments?

Any of those events could have affected his ability to pay; not all of them are morally questionable.

To add insult to injury for the working poor, a former last resort -- declaring personal bankruptcy -- has become increasingly difficult, and expensive. Rudolf notes that "sweeping changes to federal law in 2005 -- pushed by the banking lobby -- complicated the process and more than doubled the average cost of filing, to more than $2000. Many low-income debtors must save for months before they can afford to go broke."

Despite the tightening, the recession has had its expected effect: "More Americans filed for bankruptcy protection in March than during any month since the federal personal bankruptcy law was tightened in October 2005, ...a result of high unemployment and the housing crash," with federal courts reporting nearly 7000 filings a day, up 35% from February, according to Duff Wilson's article in today's New York Times.

So which is the more immoral: the consumer falling behind through no fault of his own, or the banker garnishing his wages to the tune of 27.55%?