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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)

American women age 65 or over may not pursue mammography screening for breast cancer because they have to pay part of the cost. An analysis of Medicare bills in 1991 and 1992 of 4,110 women 65 and over revealed that only 36.9% took advantage of the screening mammography benefit of Medicare. Medicare pays for most of the cost of screening mammography, but people without supplemental insurance have to pay copayments, deductibles, or balance bills. Balance bills are issued by health care providers who charge above the Medicare amount. Less than 15% of women without supplemental insurance had mammography, compared to 44.7% of women with employer- supplemented insurance, 40.1% with self-purchased supplemental insurance, and 23.9% with Medicaid supplemental insurance.

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.

Long-term treatment and facilities (LTCFs) offered to chronically-ill persons with AIDS (PWAs) are ill-suited for AIDS patients. Provision of long-term care for PWAs involves problems such as reimbursement, ignorance about HIV transmission and hostility of society toward AIDS-affected patients. Despite these problems, more long-term care centers with advanced medical care must be established to provide treatment for the increase in the number of chronically-ill PWAs.