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Federal social program evaluation has blossomed over the past quarter century. Despite this growth, there has been little accompanying public debate on research ethics. This essay explores the origins and the implications of this relative silence on ethical matters. It reviews the federal regulations that generally govern research ethics, and recounts the history whereby the evaluation of federal programs was specifically exempted from the purview of those regulations. Through a discussion of a recent evaluation that raised ethical concerns, the essay poses--but does not answer--three questions: (1) Are there good reasons to hold federal social program evaluations to different standards than those that apply to other research?; (2) If so, what ethical standards should be used to assess such evaluations?; and (3) Should a formal mechanism be developed to ensure that federal social program evaluations are conducted ethically?

BACKGROUND: Phthalates have antiandrogenic effects and may disrupt lipid and carbohydrate metabolism. Racial/ethnic subpopulations have been documented to have varying urinary phthalate concentrations and prevalences of childhood obesity. OBJECTIVE: We [...]

Objectives This research studied the relative contribution of diabetes mellitus to the increased prevalence of tuberculosis in Hispanics. Methods. A case-control study was conducted involving all 5290 discharges from civilian hospitals in California during 1991 who had a diagnosis of tuberculosis, and 37 366 control subjects who had a primary discharge diagnosis of deep venous thrombosis, pulmonary embolism, or acute appendicitis. Risk of tuberculosis was estimated as the odds ratio (OR) across race/ethnicity with adjustment for other factors. Results. Diabetes mellitus was found to be an independent risk factor for tuberculosis. The association of diabetes and tuberculosis was higher among Hispanics (adjusted OR [[OR.sub.adj]] = 2.95; 95% confidence interval [CI] = 2.61, 3.33) than among non-Hispanic Whites ([OR.sub.adj] = 1.31; 95% CI = 1.19, 1.45); among non-Hispanic Blacks, diabetes was not found to be associated with tuberculosis ([OR.sub.adj] = 0.93; 95% CI = 0.78, 1.09). Among Hispanics aged 25 to 54, the estimated risk of tuberculosis attributable to diabetes (25.2%) was equivalent to that attributable to HIV infection (25.5%). Conclusions. Diabetes mellitus remains a significant risk factor for tuberculosis in the United States. The association is especially notable in middle-aged Hispanics. (Am J Public Health. 1997;87:574-579)

Many studies demonstrating an association between race and the use of medical services have used hospital discharge abstract data. The quality of the measures of race in such data sources has heretofore been unexplored Hospital discharge abstract data from New York State were used to identify 767 cardiac patients who had been admitted to a hospital twice. Racial classifications during the two admissions were concordant 93.7% of the time. Kappa was .89 for Blacks, .72 for Whites, and .43 for all other racial groups. Evidence suggests that the misclassification of race in hospital discharge abstract data is nondifferential; racial discrepancies in access to medical services are thus probably even greater than those previously reported. (Am J Public Health. 1994;84: 1018-1021), Information on race is often drawn from hospital discharge data, but racial classification for those who are neither black nor white may have a high degree of unreliability. Race is often assigned by hospital clerks upon admission, and in emergency cases or because of sensitivity issues, the classification is often made by observation rather than questioning. Researchers analyzed data from the medical records of 2487 people who had a first hospital admission for heart attack and were readmitted to a hospital within six months. Racial classifications were compared for the 767 people admitted to a different hospital versus those readmitted to the same hospital. Agreement between the two separate classifications was highest for blacks, followed by whites. There was substantial disagreement between the two classifications for people of other races, including Asian and American Indian. Misclassification can skew results of studies that compare medical care based on race.

Objectives. This study examined the impact of duration of physician-patient ties on the processes and costs of medical care. Methods. The analyses used a nationally representative sample of Americans 65 years old or older who participated in the Medicare Current Beneficiary Survey in 1991 and had a usual source of care. Results. Older Americans have long-standing ties with their physicians; among those with a usual source of care, 35.8% had ties enduring 10 years or more. Longer ties were associated with a decreased likelihood of hospitalization and lower costs. Compared with patients with a tie of 1 year or less, patients with ties of 10 years or more incurred $316.78 less in Part B Medicare costs, after adjustment for key demographic and health characteristics. However, substantial impacts on the use of selected preventive care services and the adoption of certain healthy behaviors were not observed. Conclusions. This preliminary study suggests that long-standing physician-patient ties foster less expensive, less intensive medical care. Further studies are needed to confirm these findings and to understand how duration of tie influences the processes and outcomes of care. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Opening the Market for Lower Cost Hearing Aids: Regulatory Change Can Improve the Health of Older Americans" by J. Blustein and B.E. Weinstein which appears in a 2016 issue of the journal.