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O'Neill School Undergraduate Thesis Blog Indiana University Bloomington

Working Together Solves Environmental Issues

Posted on by eriehrma

Who would have thought it, but working together to solve a problem actually works. The Great Lakes-St. Lawrence Watershed is the heart of the Midwestern portion of the United States and Canada. The Midwest is home to more than just friendly people and ranch dressing on everything. According to the Brookings Institution, that as an economic unit, the Midwest is the world’s third-largest economy. Due to its industrial heritage, this economic progress has come at the cost of the region’s aquatic ecosystem. The Midwest may be considered fly-over country, but its importance to the world’s economy and ecosystem cannot be understated.

To understand what the governments of the watershed are doing to combat this widespread ecological issue, I examined the Great Lakes-St. Lawrence Compact before and after the implementation of the Compact. This agreement occurred in 2005 and was fully ratified in 2008. This agreement led to the further development of the Compact Council, which consists of the American states of Illinois, Indiana, Minnesota, Wisconsin, Michigan, Ohio, Pennsylvania, New York, and the Canadian provinces of Quebec and Ontario. The treaty is notable since it allows for further collaboration of the management of the watershed, the inclusion of stakeholders, and creating additional discharge regulations. The Compact is a perfect example of how governments can work together to prevent the pollution of a significant resource.

The Great Lakes-St. Lawrence watershed ecosystem possesses many different types of environmental issues. The first issue that I examined was the total amount of discharge from the watershed. The Compact Council has made it a historical priority to reduce the total amount of outflow. Considering this factor provides an essential insight into how effective the council is at creating for long-term priorities. The second ecological issue I examined was the phosphorus in Lake Erie. I only studied Lake Erie because it has had a historical problem of phosphorus management and its proximity to a plurality of the members of the Compact Council. The third ecological issue that I examined was the total levels of PCB in fish tissue. PCBs in fish tissue provides a competent measure for the health of the aquatic animals and the total amount of the chemical in the ecosystem. In addition, examining PCBs in tissue is essential to understand how the pollution in the water can affect human health. The ecosystem is complex and more factors need to be considered in the future.

My research findings show that there is a relationship between the implementation of the Compact Council and the reduction of the ecosystem health hazards in the watershed. To learn about the Council’s impact, I ran a time-series analysis before and after the implementation of the agreement. Using a time-Series analysis is the most appropriate type of test because it allows for the examination of the ecological factors before and after the agreement. I examined the years of 2000 through 2004 to establish for use as a baseline of the ecosystem health. After running my pre-agreement analysis, I reviewed the years of 2011 through 2015 to learn how the agreement has affected the ecosystem. The agreement allows members to work closer together.

The ecosystem has improved since the implementation of the agreement. Although the total amount of discharge increased after the implementation, the rate of discharge decreased. I believe this is due to the policy implementation lag. The rate of discharge reduction shows that the Compact council is making progress in its goal of protecting the water levels of the watershed. After examining Lake Erie phosphorus data, it can be seen that the total amount of phosphorus is decreasing. The addition rate phosphorus decreased after the implementation of the agreement. This shows that member states are making progress towards reducing the ecological limiting factors in the watershed. The amount of PCBs in the watershed decreased over time. Despite the increase in the rate of this chemical of concern, I believe that this is due to the prior policies reducing the majority of the pollutant in the watershed. All that is left of this chemical of concern is residual amounts. The ecology of the watershed is slowly getting better.

The Great Lakes-St. Lawrence watershed is a valuable ecological and economic resource. The Compact Council has made a lot of progress towards protecting this resource through a collaborative governance management regime. To improve upon the gains, the Compact Council members should work towards harmonizing their policies. This would allow for stronger management regime. Water is the lifeblood of all life, and it is important to conserve our surpluses now for use in the future.

Homicide by Drought in Honduras

Posted on by aroquena

In 2006, Honduras had a homicide rate of 59.1 per 100,000 people, making it the most dangerous country in the world outside of a war zone. There are many contributing factors to this rate of violence, from socio-economic inequality to the 2009 coup. At the same time, the Honduran economy is heavily reliant on its agricultural sector. Drastic shifts in harvests can have negative impacts on vulnerable small-scale farmers, increasing the odds of migration or joining illegal organizations. As a result, the risk of violence may increase. To test the sequence of rainfall variation, harvest production levels and homicides, I conducted a study using data on rainfall and homicide rates from 2005 to 2016 to see if variation in rainfall had any effect on homicide rates in Honduras.

My results showed that rainfall has drastically more influence on homicide rates when years are split into wet and dry seasons. Rainfall variation from the average had little connection to homicide rates from 2005 to 2016. This may be due to the general level of drought Honduras currently experiences. Any water during wet seasons may be a good thing. Dry seasons also had a similarly weak connection. However, when controlled for the 2009 coup, rainfall deviation during dry seasons had an incredible correlation with homicide levels for subsequent years with an R-squared value of 0.84. From 2005 to 2016, dry season months averaged 500 inches of rain. Rainfall drastically below this average resulted in higher homicides in subsequent years and vice versa.

There are several implications for these findings. NGOs and state actors should focus efforts on continuing the irrigation of Honduran farmlands. Honduran subsistence farmers, which account for 70% of the Honduran agricultural sector, rely primarily on rain fed agriculture. This practice puts farmers at risk when there is extended drought or flooding from extreme rainfall events. Currently less than 10% of the Honduran agricultural sector uses irrigation. Developing irrigation for the rest of the nation will lower the risk of economic straits from poor harvests due to rainfall variation. This in turn will increase the opportunity costs of migrating, joining illegal organizations, or engaging in interpersonal conflict. As climate change continues to interfere with regular rainfall and temperature levels, it will be important to continue to develop strategies to mitigate and adapt in order to maintain stability, especially in developing nations. Further research could incorporate temperature into analyses to account for evaporation of water from soil and localized weather and crop data to get clearer pictures of where and how rainfall deviation affects different communities.

Did “Political Correctness” Crash the Housing Market? Evidence on The Community Reinvestment Act and Mortgage Outcomes

Posted on by johnwals

In the aftermath of the 2008 American housing crisis and the subsequent global economic recession, John Derbyshire wrote the following in the National Review, “The folk losing their homes? Are victims not of ‘predatory lenders,’ but of government-sponsored — in fact government-mandated — political correctness.” The ‘political correctness’ Derbyshire was referring to was the 1977 Community Reinvestment Act or the CRA. The CRA is a piece of federal housing legislation that was passed to encourage large, federally insured banks to increase the provision of financial services to the communities in which they were chartered to exist. Passed alongside a series of comparable housing and community development law, the CRA was part of a broader attempt by congress to attend to the growing concerns surrounding the prevalence of financial inequity. Banks based in metropolitan areas were systematically taking in deposits from surrounding lower-income communities but making their financial services (mortgages, small business loans, etc.) widely inaccessible to those same communities.

In order to redirect lending, the CRA relied on an incentive system. It granted four federal financial agencies and offices the power to review and grade how bank’s lending portfolios (where lending was going and in what volume) aligned with the goal of the CRA. These institutions would then consider that grade when approving future requests for mergers, acquisitions and a series of other federally regulated banking activity. But for the first decade after its passage, the CRA resulted in zero penalties and was widely considered just federal lip service on the concerns of financial inequity. Enter 1989 and the Financial Institutions Reform, Recovery and Enforcement Act (FIRREA). FIRREA remains to be one of the most substantial overhauls of federal financial law and regulation, carrying in it a vast array of implications for the financial sector. Of particular significance to the CRA, FIRREA resulted in the publicization of mortgage lending data from federally insured banks. Following FIRREA, community groups, watchdog agencies and journalists were able to use mortgage data to better hedge the CRA against targeted banks. Community members threatened boycotts and urged lawmakers to hold these banks accountable, a concept known as ‘regulation from below’. With increased pressure from the general public, 1989 marked the first ever penalty given out under the CRA.

Riding on the momentum of FIRREA, in 1995 the CRA was reformed to provide a more structured and rigorous grading process. Included in this process was the lending test, which measured the volume of lending going to CRA-eligible borrowers inside a banks chartered area. Borrowers could be “eligible” for the lending test in two ways; they could make an income that was less than 80% of the metropolitan area’s median income or live in a census tract that had an average income under that cutoff. Following 1995, the impact of the CRA grew more noticeable, with greater penalties being given out and the banking industry being increasingly cognisant of compliance.

How did we get from the story above to the comment made by John Derbyshire? The connection exists in the ongoing debate between academics on the topic, with two mutually-exclusive groups butting heads. The first group is represented by a series of research concluding that the incentive system created by the CRA coerced banks into abandoning safe and sound lending practices in order to meet quota-like lending marks. They back this with data correlating CRA eligibility (as determined by the lending test) with higher delinquency rates prior to 2008. The second group is a denunciation of that claim, arguing instead that the data shows no relationship between the CRA and delinquency, with even some evidence suggesting that CRA eligible lending performed better in the aggregate.

So which side is right? And why such sustained disagreement?  Some disagreement arises out of a research challenge with the Act; isolating the impact of CRA eligibility from the exogenous effect of income on loan performance. Using a thorough dataset of a sample of approximately 60,000 loans made by a large lending institution in Southern California between 2002 and 2006, I used a regression discontinuity design to get around this challenge. The discontinuity method allowed me to compare two borrower groups that were just on either side of the 80% cutoff point in the lending test. Given such a small difference in income, any major difference in delinquency rates are likely the effect of the CRA. What I found was that there was no major difference and that the income group just above the 80% cutoff actually performed slightly worse.

Beyond this method, I performed statistical analyses that showed higher probability of default among both low-income borrowers outside of low-income census tracts and high income borrowers inside low-income census tracts–but the probability of default among the latter group is far more substantial. This builds a different narrative around the impact of the CRA. As opposed to low-income borrowers defaulting at higher rates, it seems that the more significant default rates were associated with high-income borrowers buying homes in developing neighborhoods, most likely in search of a profit. That the CRA encouraged lending to affluent housing speculators was certainly not the intention of the act but rather suggests a flaw in the policy design. While claims like John Derbyshire are outlandish given the results of the discontinuity, the broader statistical analyses I performed draw attention to the importance of policy design. Policy makers need to be more specific when defining who they intended to serve and consider how policy may be abused. Otherwise we will continue to see federal incentive systems be blatantly manipulated.

The time to govern artificial intelligence is now, and here’s how we can do it

Posted on by branperr

The ancient Chinese board game Go is the ultimate strategy game. It has a few simple rules. But, these simple rules create the most complex strategy game of all time, with more potential combinations of games than there are atoms in the observable universe. In 2016, humans were no longer the best at playing Go, joining the ranks of chess and Jeopardy having been conquered by artificial intelligence. AlphaGo, the program that beat the world champion, not only beat the world champion, but the strategy it used overturned centuries of collective wisdom on Go strategy. To go further, another program called AlphaGo Zero learned by doing nothing but play against itself over the course of three days and beat the original AlphaGo 100-0. This is the power of artificial intelligence, and the number of domains that its becoming superhuman at are growing larger.

Artificial intelligence is being applied in areas outside of board games; areas that might result in disaster. It can be applied to weapons like drones and tanks that can act without any human input, find strategies, network together, and act with superhuman speed. Smart viruses are also a major concern, especially given how poor the state of cybersecurity is. There are other concerns too, but the biggest and potentially the most dangerous is artificial superintelligence, a hypothetical AI that could outsmart humans in any domain of intelligence, including social and emotional intelligence. We not only have to worry about these things being used maliciously, but also the unintended consequences of its use. These programs do what they’re programmed to do, not what they’re intended to do, and the smarter they are, the greater the consequences. Imagine if you’re driving a car 40 mph down the road. If the steering wheel is slightly off, no big deal; you can adjust it. If you’re going 40,000 mph, then a slight misalignment results in you smashing into the side of the road. This is the nature of powerful value-misaligned intelligence, and the brooding arms race in intelligence can make issues like this worse. That’s a lot to deal with.

So how do we stop humanity from crashing into the side of the road? That’s a difficult question, but regardless, there needs to be some sort of governance on an international scale to handle these issues. I looked at a few factors to try and determine what the best governance system might look at. First, instead of letting the car smash into the side of the road and try to pick up the pieces, we should avoid that situation to begin with. So, this governance system should be anticipatory, working with different stakeholders in capacity building and foresight on these issues. Political factors also need to be taken into consideration so that we can understand what sort of issues might prevent cooperation. Then, by comparing the strengths, weaknesses, and issues with previous governance frameworks, we might be able to determine which is best.

Because AI is such a new technology and there hasn’t been a lot of international discussion of the topic, I decided to look at cybersecurity as a proxy field to understand what political issues there might be. I looked at the United Nation’s 2016/2017 Group of Government Experts meeting regarding the state use of information communication technologies (ICTs), which focused on norm building and the interpretation of international law in the context of ICTs. To say the least, the meeting failed to reach a conclusion because of the conflicting interpretations of international law between Western countries and more authoritarian countries like Russia and China. One of the key issues is over what defines sovereignty. Since the sovereign can only define sovereignty, countries like Russia and China view the management of all information going into and out of their borders as key to maintaining their regimes, which conflicts with the West’s view of freedom of expression as a human right. This not only signifies that there are fundamental differences in interests and values that could prevent cooperation with AI, but it shows that the vague and conflicting nature of international law might prevent it from being an effective means of creating cooperation.

So, with all this in mind, I looked at four different governance frameworks: soft-law, multi-stakeholder governance, multilateralism, and polycentric governance. Soft-law focuses on the creation of norms and non-binding agreements. Multi-stakeholder governance tries to bring together relevant stakeholders including corporations and civil society groups, to have everyone voice their opinions and collectively make and enforce decisions. Multilateralism just involves nation states creating agreements, such as the United Nations. Finally, polycentric governance is where there are multiple self-governing groups with multiple centers of decision-making that are informally networked with one another and pursue problems as they see fit. These organizations are autonomous but are also nested together with overlapping jurisdiction and different levels of authority, such as states, regional jurisdictions, or international bodies of governance.

Ultimately, after comparing the different strengths and weaknesses of these governance frameworks, I decided that a multilateral version of a specific type of soft-law regime called a ‘Governance Coordination Committee’ (GCC) that helps direct actors within a larger polycentric community might be the best way forward. This GCC would act as an issue conductor that helps manage the community of people working to reduce risk and other stakeholders in industry and government. It would also help find areas of cooperation, sponsor research, guide technological development, and drive norms. While this isn’t a final solution to the problem, it can help create the conditions for further agreements in the future. It’s time to start governing artificial intelligence, and this GCC-Polycentric approach is something that can be implemented now.

The Sky’s The Limit? Increasing Aviation Safety In Air Traffic Control

Posted on by mwwatkin

My study examined whether the organizational structure of air traffic control affects public safety outcomes. Air traffic control is a service where air traffic controllers direct planes on the ground and in the sky to keep safe distances between aircraft, prevent collisions, and guide pilots in inclement weather and complex airspace. As air travel continues to increase, there will be pressure on the Federal Aviation Administration to ensure a National Airspace System free of delays – while still ensuring the highest levels of aviation safety. The Federal Aviation Administration is a U.S Federal Agency responsible for the regulation of civil aviation and air traffic control in the United States. The figure below shows a graphic of how air traffic control works, from the moment a plane leaves the gate at an airport to when it lands at its destination.

While aviation accidents and air traffic errors are rare, they can be hugely consequential when they do occur. On September 26th, 2014, a disgruntled contracted employee set fire to the basement of the Chicago Air Route Traffic Control Center. This destroyed all of the communications equipment the center used to communicate with airplanes in its airspace.

The figure above shows a snapshot of busy air traffic across the national airspace system. The figure below shows the airspace around Chicago after the center fire. This accident placed large amounts of stress of the nation’s air traffic system and greatly increased the risk of an accident. This example of radar facility sabotage shows that there is still work to be done in ensuring a safe national airspace system. My study focused on the organizational structure of air traffic control and public safety, as technological upgrades alone will not take the human factors out of air traffic management.

Methodology

For my study, I interviewed over 20 air traffic controllers and Federal Aviation Administration management officials. I also analyzed Government Accountability Office reports and existing FAA plans to see plans for the future air traffic system. While I expected to see a clear sequential relationship between organizational structure, management practices, and aviation safety outcomes, I ended up finding a more clear direct relationship between organizational structure and public safety outcomes. Management practices did have an impact on safety, but its effect was much more varied than organizational structure.

How Organizational Structure Matters

A big takeaway of my study is that the organizational structure of air traffic control services matters has a direct relationship to aviation security and public safety.

1981 PATCO Strike And Mass Firing

One event affecting the organizational structure of air traffic control in the United States is the mass firing of striking air traffic controllers in 1981. The firing of approximately 11,000 air traffic controllers caused a major staffing shortage, one that continues to this day. Following President Reagan’s firing of the striking air traffic controllers, the FAA aggressively hired in the following years to make up for the loss. Now, however, the controllers hired during that period are starting to retire, threatening another demographic bust in the controller workforce at the FAA. This new wave of mass retirements has already put stress on many facilities, leaving the controllers there working more overtime, and at higher risk of fatigue and distraction.

Inconsistent Funding Stream

As a United States Federal Agency, the Federal Aviation Administration is subject to the congressional appropriations process. This can cause a great amount of budgetary instability for the FAA, as its budget is subject to political brinksmanship and sometimes sudden budget cuts. The budget sequestration of 2013 is a strong example of how across the board cuts resulted in frozen hiring, furloughed controllers, and delays across the National Airspace System.

Issues with Contracting

Issues with contracting also pose a threat to aviation security and public safety. A contracted employee was the root cause of the 2014 Chicago Center fire. Additionally, respondents described how contracted employees stole government computers from Indianapolis Center. FAA employees are subject to rigorous background checks, medical, and mental health clearances. These events show there may not be enough safeguards in the work that the Agency does with contractors.

Government Pay Structure

Currently, FAA employee’s salaries are capped at $189,600. Although Air traffic controllers command high wages due to the highly technical nature of their work, this cap is becoming an issue for the FAA’s development of high performing employees. Several respondents mentioned how the bump one would receive in pay in they were promoted to management is much less now than it used to be. This may be holding well qualified controllers back from jumping into supervisory roles, because of the additional responsibilities it carries does not outweigh the now much smaller pay increase. This affects safety because effective supervisors play an important role in overseeing air traffic operations and preventing errors.

Management Also Matters

I also found that management practices have an impact on public safety, though to less of an extent than organizational structure.

Positive Collaboration Between Management and NATCA

Positive relationships between the National Air Traffic Controllers Association and FAA management can help with aviation safety by collaboration on facility safety councils. These safety councils analyze safety trends of air traffic control operations, and look to prevent safety issues from becoming problems. The leadership and relationships of the air traffic controllers union and FAA management can vary widely by center, and has more of a localized effect than other variables impacting aviation safety.

Shift From Blame Culture to Reporting Culture

Additionally, the Agency has shifted from a blame culture to a reporting culture. There used to be very severe penalties if a controller made even a tiny mistake. Now there is an anonymous safety reporting system that gives some protections for controllers that report errors. This way there is more safety data to analyze, so that centers can proactively address safety issues, rather than being reactive. However, some respondents felt that this reporting system gives those that makes mistakes too little accountability and that it may not be a sufficient motivator for improved performance.

 

Giving Multilateralism a Cold Shoulder: Russian Domination and Exploitation of Frozen Conflict Zones

Posted on by Kieran

Russia—through arms trade, financial resource assistance, and war—establishes itself as a power maintaining control in its region. However, complete stability continues to escape the Kremlin due to frozen conflict zones, intra-state regions struggling to attain independence. Formed after the dissolution of the Union of Soviet Socialist Republics (USSR), frozen conflict zones endure in an atmosphere eschewing direct war; but, lacking peace as well. These areas include Transnistria, Abkhazia and South Ossetia, and Nagorno-Karabakh. Russia challenges the sovereignty of Moldova, Georgia, Armenia and Azerbaijan, respectively. Russian power in these areas remains mostly unchallenged by the international community. This is explained by the dominance of Russia within the intergovernmental organization (IGO) network.  Although Transnistria, Abkhazia and South Ossetia remain concretely within Moscow’s grip, Turkey, Iran, and Georgia continue to combat Russian ambitions in Nagorno-Karabakh.

METHODOLOGY

I used previous writings in International Relations Theory, foreign-language resources, research documents, and data from the Stockholm International Peace Research Institute and RAND Corporation to conduct analysis of frozen conflict regions and the role Russia plays.

SYSTEM EFFECTS AND INTERGOVERNMENTAL AGENCIES

Frozen Conflict Russian Military Force Present? Ongoing OSCE Mission Present?Transnistria Abkhazia South Ossetia Nagorno-Karabakh

Contingency effects are outcomes that are predicated on a multitude of interactions and are not inevitable. The rise of Russia was non-inevitable, especially given its weakened status during the mid-1990s. Contingency effects in the form of interactions between nations in intergovernmental organizations explain for Russia’s triumphant return to the world stage. The Organization for Security and Cooperation in Europe (OSCE) represents the main intergovernmental organization (IGO) in the area. It often succumbs to Russian interests. One such area is the ineffectiveness of the Minsk Group, a peacekeeping force in Nagorno-Karabakh. Leadership of the Minsk Group includes personnel from the United States, France, and Russia. The Kremlin maintains a seat at the decision-making table in the Minsk Group, because it presents itself as the only solution to these regional problems and the other powers cooperate on Russia’s terms. Thus, Russia is able to control the actions of an important arm of the OSCE, preventing harmful retaliation against its own efforts in the region.

Interaction effects are those which occur from events that change the landscape of an issue. For example, Russia’s invasion and war with Georgia altered the strategies of other states engaged in the South Caucasus. The Russo-Georgian War signaled to regional entities that Moscow was willing to wage war to gain territory and power. Abkhazia and South Ossetia promised troops to the Russian cause pursuing the carrot of independence Russia dangled before them. Such outright violence promised a more cautious approach in the area by foreign powers. In 2008, Russia waged war on Georgia, with the help of military personnel from Abkhazia and South Ossetia. Afterwards, as illustrated in the table above, rather than combating Russian aggression, the OSCE bowed to Russian dominance, ceasing mission efforts in Georgia.

EQUILIBRIUM AND STATE ACTORS IN FROZEN CONFLICT ZONES

While the OSCE’s efforts fall flat, area states continue to push back against Russian influence in their neighborhood. Equilibrium Theory—the notion of analyzing states’ military-political and socioeconomic capabilities as a central function of their combined ability to balance an aggressor—explains this behavior. When states are unwilling or unable to counterbalance an aggressor’s actions, equilibrium, a status quo, persists. Equilibrium exists in the South Caucasus frozen conflict zones, considering their almost thirty-year lifespans.

The conflicts of Transnistria, Abkhazia and South Ossetia remain in equilibrium due to Moldovan and Georgian inability to alter the system by combatting Russia through military-political or socioeconomic capabilities; in Nagorno-Karabakh, however certain states push against Russia, engendering a complex equilibrium in which Russia is not the sole authority. Turkey, Iran, and Georgia represent the greatest threats to Russian ambitions in the South Caucasus.

Russia funds resources, including arms and finances to both Azerbaijan and Armenia, hedging its bets regardless of who attains control of frozen conflict zone between them, Nagorno-Karabakh. Although Armenia prefers Russian power, Azerbaijan allies itself more closely with Turkey, Iran, and Georgia. As a result, the latter states retain enough influence in Azerbaijan to deter Russian ambitions and aid Azerbaijan in acquiring Nagorno-Karabakh. Turkey and Iran share historical-cultural backgrounds with Azerbaijan and contribute to it through both military-political and socioeconomic tactics including arms trade and investment. In addition to arms trade, Turkey and Georgia continue to develop pipelines and railways through their countries that originate in Azerbaijan. These connections create a socioeconomic counterbalance to Russian attempts. However, Turkey and Georgia do not provide quite enough military-political nor socioeconomic help to completely prevent Russian influence from spreading; but they restrain it to a minimum.

POLICY IMPLICATIONS

System Effects Theory and Equilibrium Theory are frameworks which explain the rise of and subsequent control wielded by Russia. Moving forward, three conclusions become clear:

1. Focus Russian-power balancing diplomacy efforts on Nagorno-Karabakh

2. Challenge Russia’s power of the purse

3. Recognize frozen conflict zone independence with conditions

Because Nagorno-Karabakh is primarily a conflict between Armenia and Azerbaijan, Russian sway is not as prominent as in the other frozen conflict regions. Powers seeking to upend Russian dominance should focus their energy on diplomatic efforts that bring Armenia and Azerbaijan to the negotiation table, as their distance encourages Russian intervention and hedging.

Russia’s gross domestic product last year was approximately $1,283,163 USD. This is almost equivalent to Turkey’s, Iran’s, and Georgia’s GDPs combined. Challenging the economic prowess of Russia is therefore important. To counteract Russian donations to Azerbaijan and Armenia, other states in the international system ought to provide more economic resources.

Finally, recognizing the independence of frozen conflict regions would go a long way to coercing their cooperation. However, these areas persist within established states, and their independence threatens sovereignty. Therefore, a conditional independence in the frozen conflict zone would be arranged; decisions made at the frozen-conflict-level would be communicated to the state-level authority.

 

Profit vs. Patient Care: How can we keep pharmaceutical companies accountable?

Posted on by amkupty

The United States is notorious for its extravagant spending on healthcare and the climbing costs of prescription drugs. In what seems to be a time of unjustifiable pharmaceutical price spikes, what is keeping pharmaceutical companies accountable?

The pharmaceutical industry is one of the most profitable sectors in the U.S., partly due to the minimal regulations imposed on it. Indeed, it is difficult to forget the actions of former Turing Pharmaceuticals CEO, Martin Shkreli, who suddenly raised the price of Daraprim from $13.50 to $750 per tablet when its generic form was not yet available in the U.S.

Pharmaceutical companies often justify these price spikes by stating their need to balance pricing with innovation—they need to be able to pay for future research and to cover costs of unsuccessful projects. There unfortunately is little information on how they do so.

This lack of transparency not only exists in price setting, but also in product marketing. Marketing is essential for fueling profits and compensating for the costs of innovation. Unsurprisingly, there has been a lack of accountability for pharmaceutical companies’ roles in direct-to-physician marketing—their primary method of sales promotion.

Direct-to-physician marketing is the promotion of pharmaceutical products to physicians. Most of these promotions are conducted by pharmaceutical sales representatives, who can give payments to physicians in the form of buying lunch, giving gifts, or giving out free drug samples in the time they have to discuss the product of interest.

Many are concerned about how these interactions influence prescribing habits. Did my physician (either consciously or subconsciously) choose to prescribe this drug to me because they truly think it is in my best interest, or did that charismatic pharmaceutical rep influence their choice? Without records of these financial exchanges, it is difficult to tell.

There were no national records, and therefore no accountability for these exchanges until 2010, when the Affordable Care Act introduced the Physician Payments Sunshine Act (PPSA).

The PPSA mandates that pharmaceutical manufacturers report any payments made to physicians valued over $10 or which sum to over $100 in a year. Information is then managed by the Centers for Medicare and Medicaid Services (CMS), who publishes the data online for public access.

I used these published financial records for 2014, 2015, and 2016, to evaluate possible pharmaceutical marketing strategies for antidepressants and anti-anxiety medications—one of the top most utilized prescriptions. I assessed whether pharmaceutical companies market these drugs based on a strategy of potential patients. That is, whether they market more to physicians working in communities that are more likely to contain patients who have depression and anxiety disorders, and are therefore more likely to utilize these medications.

I characterized these communities of potential patients using demographic and health factors. I then explored relationships between these factors and the amount of money physicians were paid for the marketing of antidepressants and anti-anxiety medications.

This images illustrates the counties in which physicians received promotional payments for antidepressants and anti-anxiety medications in the year 2016. Darker shades indicate greater payment amounts (minimum = $0.11, maximum=$4,350.00). My study sought to explore the relationships between these payment amounts and the characteristics of populations living within these counties.

The demographic factors I evaluated were gender, elderly population, non-White Hispanic population, rural population, median household income, and those with some college education. The health factors of interest were physical inactivity, adult obesity, heavy drinking, and violence in the counties in which recipient physicians work.

Overall, the uneven distribution of payments to physicians by pharmaceutical companies demonstrated the existence of a specific marketing strategy. I found, however, that pharmaceutical marketing of antidepressants and anti-anxiety medications directly to physicians does not seem to be guided by the people these physicians are more likely to treat.

Independent analyses between the payment amounts received by physicians and the demographic or health characteristics of the people living near them revealed some relationships, but these were very minimal. Even when looking at all of these demographic and health factors together, rather than separately, there were still weak associations with the amount of money physicians were paid.

In terms of the locations of physician marketing, pharmaceutical companies marketed antidepressants and anti-anxiety medications to more rural areas, compared to the locations in which they marketed all types of medications. This might be connected to the potential for market growth.

The results imply that pharmaceutical companies do not market antidepressants and anti-anxiety drugs based on the potential pool of patients. That is, they do not mainly target physicians who are more likely to treat people with depression and anxiety.

This raises some questions then, as to what the actual marketing strategy is. Perhaps the uneven distribution of payments is dictated by how receptive physicians are to these interactions. Maybe companies market to physicians closer to company headquarters. Or perhaps they target areas with the greatest market growth potential.

Whatever the case, it is important that we use the newly available transparent financial records to continue to examine pharmaceutical-physician relationships. If we can understand pharmaceutical marketing strategies, then we may become aware of which people are most vulnerable to biased patient care.

After all, there is an inherent trust between a physician and a patient, but with minimal regulations, pharmaceutical companies threaten that trust while in pursuit of a profit. Research on these financial records, however, would help restore that trust by holding pharmaceutical companies accountable.

Undergraduate Research for the Greater Good

Posted on by Professor Baggetta

CARI program students and faculty at the 2018 thesis symposium. [Photo credit: Jim Hanchett for SPEA]
The Paul H. O’Neill School of Public & Environmental Affairs at Indiana University offers two opportunities for undergraduates to conduct their own original research projects and write an undergraduate thesis presenting their results: the O’Neill Honors Program and the Certificate in Applied Research and Inquiry (CARI) program. During the capstone course for both programs, students complete a piece of original research and present it in several forms. They write a senior thesis (a 6,000-12,000 word research manuscript, akin to a scholarly journal article) and they do a 12-minute public presentation (akin to an academic research conference). They also communicate their research findings to a broader audience by writing a research blog post. This site is the home for those posts–and for students’ reflections on what they learned going through the research and writing process.

If you are in one of these programs–or are thinking about entering one of them–take a look at the Research posts for examples of the kind of work you will one day be doing, and check out the Advice posts for sage wisdom from your experienced elders.

If you’re anyone else… enjoy perusing the fascinating research and insightful reflections offered by these students. Feel free to comment (civilly, please). The post authors are eager to hear your thoughts. Some of them may continue pursuing these lines of research as they move on to their next academic or professional endeavors, so useful comments will be… well… useful!

 

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