Taking China’s Food Safety Problem Seriously (II)

By Ching-Fu Lin

[See Part I here.]

In response to the melamine-tainted milk scandal in 2008, China replaced its outdated Food Hygiene Act with the Food Safety Law, which came into effect in 2009.  The 2009 Food Safety Law includes provisions on risk assessment methods, establishment of a food safety committee, mandatory product recall requirements, and unification of food safety standards.  However, this legal reform has left many key areas of the regulatory framework intact—such as industry compliance and law enforcement.

First, the crucial problem of overlapping competencies among responsible authorities is not addressed in the 2009 Food Safety Law.  Although the Ministry of Health (MOH) is mandated to take the lead on food safety regulation, the current state is flawed as multiple agencies are only organized in a loosely coordinated system.  For example, the State Food and Drug Administration (SFDA), the Ministry of Agriculture (MOA), the State General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ), and the Ministry of Commerce (MOC) all take part in the regulation of the entire food supply chain.  The result is a fragmented regulatory environment, which creates blind areas for agencies to push responsibility away, and therefore, perpetuate rather than alleviate loopholes in routine control.  Thus, timely response and cooperation is difficult.

Read More

Another Legislative Win for Opioid Death Prevention

By Scott Burris

The rising public and legislative awareness of opioid overdose has been a case study in the twists and turns of culture, risk perception and the role of evidence in policy making. An interesting case study, which does not mean I understand what happened or why.

I first got involved in overdose through Dan Abrahamson, the Legal Director at the Drug Policy Alliance. This was back in 1999 or 2000, and a group of drug researchers and drug policy people convened a meeting in Seattle to discuss the chronic, neglected problem of overdose among heroin users.  There were a few health people who were highly aware of the human and economic costs, and the scale of the problem. Karl Sporer, a San Francisco ER doc, was one of the few publishing on the problem. One of the interesting ideas discussed at the meeting was distributing naloxone, the standard antidote for opioid overdose, directly to heroin users. New Mexico, which had the nation’s highest OD death rates, was trying it as a way to deal with the great distances that divided rural heroin users from EMS assistance. With Joanna Norland and Brian Edlin, I ended up writing an analysis of the legality of distributing this prescription drug to drug users.

In the next few years, led by people like Dan Bigg of the Chicago Recovery Alliance, needle exchange programs in urban areas began naloxone programs. They were spurred in 2006 when several US cities experienced an epidemic of overdose tied to the adulteration of the heroin supply with a synthetic opioid, fentanyl. By May, 2009, 57 naloxone programs were operating in 17 U.S. states.  That year, DPA funded a group of scientists and practitioners to brainstorm on how to increase drug users’ access to this life-saving intervention.  Read More

Conference Announcement and Call for Abstracts, 2014 Petrie-Flom Center Annual Conference

The Petrie-Flom Center has released the description and call for abstracts for its 2014 Annual Conference: “Behavioral Economics, Law, and Health Policy.” The conference will be held at Harvard Law School on May 2 and 3, 2014, and seeks to address the following questions:

  • Are there features unique to health and health care that prevent individuals, groups, and policymakers from making the best decisions?  What is a “best” decision, i.e., whose perspective should be paramount?
  • What types of barriers exist to rational decision making in the health care context, and what does rational decision making look like here?
  • Is exploitation of framing effects, default rules, nudges, and other elements of choice architecture appropriate when it comes to human health, or is this an area where pure autonomy should reign – or perhaps strong paternalism is needed? Is health policy special?
  • What should policymakers do when there is conflict between outcomes that might be good for individuals but not society more generally, and vice versa?  Where should the nudges push?
  • Which areas of health law, bioethics, and biotechnology policy are most amenable or resistant to manipulation of choice architecture?  When nudges are not plausible, what is the best way to overcome bounded rationality?
  • When might behavioral economics lead to the wrong results for health law, bioethics, and biotechnology policy?
  • How can manipulations of choice architecture be best evaluated empirically, and what ethical concerns might such research raise?
  • What are the most interesting or compelling health law, bioethics, and biotechnology policy nudges we should be thinking about today in the realms of obesity, organ donation, end-of-life care, biospecimen ownership and research, human subjects research, HIV testing, vaccination, health insurance, and other areas?

Please note that this list is not meant to be at all exhaustive; we hope to receive papers related to the conference’s general theme but not specifically listed here.

Abstracts are due by December 2, 2013.

For a full conference description, including the call for abstracts and registration information, please visit our website.

Bargaining Chips

By Scott Burris

Christopher Robertson recently posted here a semi-facetious suggestion of things that Democrats could ask for once the shut-down and the debt-ceiling dance turns into real bargaining. (How sad that this has to be seen as an optimistic statement.)  That’s a good idea. I think we should all join in populating the health policy wishlist.  Here’s one no-brainer.

Government is being starved, and taxes are going to have to go up somewhere.  There is no kind of tax that is not being hated on by somebody, and so no easy places to go, but there is such a strong case for raising alcohol taxes.  Alex Wagenaar, one of the greatest alcohol policy researchers we’ve produced in this country, makes a fantastic pitch for substantial increases in this short video, which is great for advocacy or teaching use.  In real terms, alcohol prices have not been lower for decades, while each drink comes with a subsidy of nearly $2 in health and health care costs we tax-payers end up paying.

So, Mr. President, how about a federal tax of $1.90 per drink, indexed to inflation.  And if there’s opposition, threaten to leave the government open!

Mental Health in the Intensive Care Unit: The Need for Early Intervention

By Michael J. Young

A prospective cohort study recently published in the New England Journal of Medicine adds to a growing body of research illuminating the neurocognitive sequelae of critical illness requiring intensive care.  Researchers reported that “one out of four patients [treated in the ICU] had cognitive impairment 12 months after critical illness that was similar in severity to that of patients with mild Alzheimer’s disease, and one out of three had impairment typically associated with moderate traumatic brain injury.”  They underscore the possible role of delirium – a syndrome of disturbed consciousness commonly seen in critically ill patients treated in the ICU – in contributing to downstream cognitive impairments.  More broadly, these findings prompt intensivists to rethink the relative priority assigned to the mental health needs of patients during ICU stays.

Read More

Another Wrinkle in Exchange Rollout? Private Sites Attempting to Lure Shoppers Looking for Exchanges

Yesterday saw two reports—perhaps the first of many—discussing the emergence of an additional wrinkle in the rollout of the health exchanges: private websites attempting to lure shoppers away from the government exchanges with websites that look and sound like the real thing.

According to an article posted by WMUR New Hampshire, the state insurance commissioner has issued a cease-and-desist letter to the owner of one website, newhampshirehealthexchange.com, that is allegedly trying to take advantage of shoppers hoping to acquire insurance through the real exchange.  New Hampshire’s not the only state dealing with this sort of issue.

Read More

Call for Papers on “Buying and Selling Health Care”

The Journal of Law, Medicine & Ethics plans to publish a symposium issue in Winter 2014 exploring ethical, legal, and clinical issues triggered by the increasing commercialization of health care in the United States. The symposium will address a variety of dynamics present in this quintessentially American medical marketplace, with a particular focus on how commercialism impacts practitioners, patients, and policy makers at all levels.

Papers from any perspective or disciplinary background and concerning any aspect of the “buying and selling of health care” are welcome.

Deadlines and submission instructions below the fold.

Read More

Taking China’s Food Safety Problem Seriously (I)

By Ching-Fu Lin

Why should we be concerned about China’s food safety problem?  A recent opinion by Adam Minter on Bloomberg offers yet another tough criticism on China’s food system: “For more than a decade, China has earned a reputation as one of the world’s worst food-safety offenders.”  Melamine-tainted milk, rat meat sold as lambrecycled “gutter oil” for cooking, and most recently, juice made from rotten fruit, Chinese food producers never cease to surprise us with their “creativity” in economic adulteration.  The Chinese government, however, has failed to establish an effective regulatory system beyond executing violators and political campaigns.  The Chinese consumers continue to react with desperation to these endless food safety crises, smuggling bunks of infant formula from Hong Kong and other countries.

But why should we care?

According to testimony before a subcommittee of the House Foreign Affairs Committee in May, food products of Chinese origin have dominated the U.S. food market in areas such as tilapia (77.5%), apple juice (65.2%), cod (52.7%), processed mushrooms (34.1%), garlic (27.4%), clams (16.1%), frozen spinach (16.0%), and salmon (12.7%).  The Chinese food imports are also expected to increase by about 10% annually until 2020.  Faced with the huge volumes of foods imported into the US every year, the Food and Drug Administration has only been able to inspect about 2.3% of the total imports from China in 2011 (which is, well, an improvement compared to 1.3% in 2007). Moreover, the U.S. Department of Agriculture announced last month that China’s poultry processing inspection system is equivalent to its US counterpart.  That is, processed chicken from China is determined as meeting US food safety standards (even if there are no on-site USDA inspectors in the processing facilities) and granted it access to the US market.

In an interdependent world trading system, regulatory failure in one country can spill over to many others, resulting in adverse public health repercussions in the latter country.  We should take China’s food safety problem seriously.

Read More

10/17 lecture, “Which Careers Do the Most Good?”

You’ll spend over 80,000 hours of your life working—you should make the most of them. But if you want to make a difference, what should you do? Work for nonprofits? Try to change policy? Find a malaria vaccine? Go into finance and give it all away? 

 Which Careers Do the Most Good?

a lecture by William MacAskill

Founder, 80,000 Hours and the Centre for Effective Altruism

 Thursday, October 17, 7:30PM

Science Center A

please RSVP here

80,000 Hours founder and Bill of Health guest blogger William MacAskill will tell you about his organisation’s research into this question, and explain how it can help you find the career where you’ll have the biggest impact. You might leave with some surprising conclusions.

William MacAskill is the founder of Oxford’s Centre for Effective Altruism and of 80,000 Hours, a personal advisory service on using your time to do the most good. Formerly a Fulbright scholar at Princeton University, and currently a PhD candidate at Oxford University, he has been featured on BBC News On-line, The Today Programme, NPR, CNBC and The Washington Post. Between them, his non-profits have raised over $3 million for the most cost-effective charities, with a further $130 million pledged.