Photo Credit: Star-Tribune
[Note: There has been considerable controversy over former Governor Arne Carlson's suggestion that the University of Minnesota suffers from a bloated administration. He has made this charge on his own blog as well as on the Star-Tribune commentary section. This piece was answered by the Chairman of the Board of Regents, Ms. Linda Cohen. Some further information about this dispute is offered below by my friend and fellow U of M alum, Mr. Michael McNabb. I hope readers will find it informative.]
In a guest column in the April 10 Star Tribune the chair of the Board of Regents responds to the criticism of excessive costs of administration at the U of M by Governor Carlson in his April 7 Star Tribune guest column.
Here is "the rest of the story" to the response of the Regents.
(1) "The university has realized millions of dollars of savings . . . . "
In January 2013 the U of M chief financial officer told state legislators that the administration has cut $228 million since 2006. See the January 31 Star Tribune report. From fiscal year 2007 through fiscal year 2012 the total operating expenses for the University were just under $17 billion. See the U of M financial reports. So the cuts amount to 1.3% of the total operating expenses. Does the administration view this as making tough choices? Or making a serious effort to control costs and tuition?
(2) "As part of our legislative request this year we have pledged to freeze Minnesota resident undergraduate tuition for two years . . . ."
The administration proposes to freeze tuition on the condition that the legislature increases state appropriations by $91.6 million for the next two years. See the September 14, 2012 Pioneer Press report.
The freeze would be limited to undergraduate tuition only (and to Minnesota residents only). The tuition for students (both resident and non-resident) in graduate and professional programs is what really compounds the crushing debt on young persons. See Whose Fault--Crushing Student Debt.
(3) "The Twin Cities campus has a lower net price (tuition, fees, room and board minus financial aid) than any other four year college in the state--public or private."
Net price does not provide any relief to the students because the administration classifies student loans as "financial aid." The Minnesota Daily describes this argument of the administration as cynical and deceptive. See Driven To Deception.
(4) "The board and the Kaler administration undertook an aggressive internal review to study . . . its administrative costs."
The Regents fail to mention that the internal study showed that the total cost of administration for fiscal year 2012 exceeded $852 million (or 28% of the total expenditures of the University). See On The Cost of Administration Part III. So their proposed $28 million reduction in administrative costs over the next two years does not make much of a dent in administrative overhead.
(5) "The column suggests that the university can operate outside the marketplace for faculty and staff salaries. . . ."
Governor Carlson limited his criticism to the compensation of administrators. He noted that universities "compare their rising costs with those of other spiraling systems and proclaim this to be the market."
The Regents should know that the law restricts the pursuit of personal wealth by the leaders of tax exempt organizations. See the Postscript to $tate of the University--A Parent's Perspective.
Society grants tax exemptions to non-profit institutions of higher education in order to promote the common good and not to enrich administrators. If the motivation of the administrators is to accumulate personal wealth, then they should seek those riches in for-profit organizations. See The Cost of "Top Talent" and The Cost of "Top Talent" Part III.
(6) "This argument ignores a reality that was unmentioned: a $140 million reduction in annual state support to the university since 2008."
Over the past decade the U of M administration has increased spending by $1 billion--despite a reduction in state appropriations. In fiscal year 2002 the total operating expenses for the University were $2,005,138,000. In fiscal year 2012 the total operating expenses were $2,948,366,000.
The fuel for this billion dollar explosion was skyrocketing tuition. In fiscal year 2002 the administration collected a net amount (after scholarships and grants) of $293,127,000 in tuition and fees. In fiscal year 2012 the net amount of tuition and fees collected was $696,278,000.
The senior administrators and the Regents have shown no mercy to the students (and their parents). This skyrocketing tuition far exceeded the reduction in state appropriations. In fiscal year 2002 the University received $643,088,000 in state appropriations. In fiscal year 2012 the amount was $572,075,000.
If the Regents are unwilling or unable to make substantial reductions in the cost of administration, then the legislature will do so for them.
Michael W. McNabb
University of Minnesota B.A. 1971; J.D.1974
University of Minnesota Alumni Association life member
[Update: The petition mentioned in this post has now been signed by more than 1,000 people including three former editors of the New England Journal of Medicine. An article has also appeared in the Star-Tribune that gives the University of Minnesota's response to the most recent developments. Please see comments on the article.]
From my friend Mike Howard:
"In November 2003, psychiatrists at the University of Minnesota used the threat of involuntary commitment to force a mentally ill young man named Dan Markingson into a very profitable, industry-funded study of antipsychotic drugs. Dan was enrolled in the study over the objections of his mother, Mary Weiss. For months Mary tried desperately to get him out of the study, warning the psychiatrists that Dan’s condition was deteriorating and that he was in danger of killing himself. The psychiatrists refused to listen to her. On May 8, 2004, Dan committed suicide, and Mary lost her only child."
As of this writing nearly six hundred people have signed a petition to Governor Dayton, including 70 scholars in bioethics/health law/medical humanities. The group includes a former editor of the New England Journal of Medicine.
The petition calls for an outside investigation without involvement of the University of Minnesota, especially its General Counsel who suffers from a severe conflict of interest.
As former Health Ombudsman in New Zealand (Health and Disability Commissioner, 2000-10) I am deeply disturbed to read of unethical behaviour by researchers and psychiatrists who enrolled Dan Markinson in a trial of antipsychotic drugs, when he was not competent to consent. It appears that evidence about potential harmful side effects of the prescribed drugs was suppressed. Dan's suicide may well be linked to the effect of the drugs he was prescribed, yet no one listened to his mother's cries for help to prevent the harm that ultimately ensued. It is now too late for Dan, but the University of Minnesota owes it to him and his mother to investigate what happened and put safeguards in places to prevent a similar tragedy happening again.
As a Senior Associate Dean for Academic Affairs at a Big Ten medical school and a practicing physician, I think medical researchers and their sponsoring institutions should be held to a high standard of ethical behavior and transparency.
As the leading institution for higher learning in the state, the University of Minnesota can, and should, do better.
The coverage of this case in the Minneapolis Star-Tribune and elsewhere generates reason to be deeply worried about possible research misconduct at the University of Minnesota. The potential misconduct appears to be serious enough that an independent investigation, located outside the university, is necessary.
Because I have worked in Psychiatric Research for close to 30 years and I find the response from UM and the sponsor to be unacceptable.
I have followed this particular case since it piqued my interested back a few years ago with an article in the Pioneer Press from St Paul. I have tried to keep an open mind and understand the University's denials of any wrongdoing. From everything I have been able to gather researching this I've come to the same conclusion over and over again. The UMN is wrong and they know it. Their repeated steps to block any type of independent investigation is disgusting. The University is acting exactly like the pharmaceutical company, if we can control the data then we can control the outcome. As I see it, Governor Dayton has no option but to order an investigation.
I teach biomedical ethics, and every student ever to take my class could tell you why this study design was profoundly immoral.
Photo Credit: Pizza Luce - Seward
Whenever I go to local restaurants, I always try to strike up a conversation with the server. Here in Minneapolis, many servers are students at our numerous colleges and universities. Having worked at a restaurant while in college, I have a lot of empathy for these folks.
Sometimes I get a big surprise. This happened recently with a server who attended MCAD—the Minneapolis College of Art and Design. When he learned that I did some polymer chemistry, he asked if I knew about the male contraceptive system, being developed in India, that was polymer based. Never heard of it. One of my colleagues, the medicinal chemist Gunda Georg, has been working in this area for some time, so I try to follow the topic. Of course, it is a very important one.
So what’s this about? A quick check revealed a very interesting story. A maverick Indian scientist, S.K. Guha is finally getting attention. He even scored a $100,00 grant from the Gates Foundation. This injectable polymeric system—styrene/maleic anhydride—is referred to by the acronym RISUG, short for Reversible Inhibition of Sperm Under Guidance. The polymer coats the interior of the vas deferens and inactivates sperm as they pass by. The method seems to work for ten years and a reversal procedure is available. According to malecontraceptives.org: “Our research has convinced us that RISUG is the most promising of the potential male contraceptives.”
So what’s the problem here? Do the clinical trials, make sure the method is safe and Bob’s your uncle? Not so fast there, pardner.
“We had no support from industry,” said Guha. As Elaine Lisser, a San Francisco activist for male contraception put it: “To men, an ideal method would be cheap and long-lasting. To company shareholders, an ideal method would be expensive and temporary.”
Now I’m not trying to push some great conspiracy theory about Big Pharm. We’ve heard it all before. They HAVE a cure for x, or y, or z, but they are not revealing it because they can make more money from selling drugs to treat the disease.
But in some public health matters there is no economic incentive for pharma to step in because they cannot make the kind of money they need to operate from something like RISUG. Another recent example of a rather simple approach to a serious problem that will probably not be too popular with pharma is the diagnosis of pre-cancerous cervical lesions with vinegar. See the New York Times article: Fighting Cervical Cancer with Vinegar and Ingenuity.
When vinegar is applied to the cervix, white spots may become visible. These resemble warts and may be removed by cryotherapy—freezing—using a metal probe cooled by a tank of carbon dioxide. Where there’s Coke, there’s CO2. This method has the potential to do for underdeveloped countries what the PAP smear has done for countries like the U.S. The death rate for cervical cancer worldwide is about 250,000. The vast majority occurring where PAP smears are not readily available to a poor population.
Intelligent use of foreign aid, Gates money, and public health research may yield more benefit than higher-tech approaches that pharma necessarily pursues.
I thank Guy Wagner, server at Pizza Luce, for calling this topic to my attention.
People who work with crystals have received an inordinate number of Nobel Prizes. Some of them receive the prize because of the importance of the compounds they have worked on. Protein crystallographers have helped to unravel the mysteries of such things as photosynthesis and how hemoglobin transports oxygen. The Protein Data Bank (PDB) is a treasure trove of interesting and useful results from crystallographic experiments. The prize has also been awarded to people who have invented new methods for the determination of structures from crystallographic data.
Usually, like most scientists, I read the news reports of the science prizes and try to understand what the winners did and why it is important. In this particular case, I saw most of the action as it developed.
Shechtman obtained experimental evidence – a diffraction pattern – for five-fold symmetry in what later came to be known as quasi-crystals. This is not supposed to happen. He realized the importance of this observation and proceeded to publish and defend it. According to a detailed scientific description of the work released by the Nobel folks: “The achievement of Daniel Shechtman is clearly not only the discovery of quasicrystals, but the realization of the importance of this result and the determination to communicate it to a skeptical scientific community.”
His jaw-dropping discovery was initially greeted with skepticism, for example:
“When Shechtman told scientists about his discovery, he was faced with complete opposition, and some colleagues even resorted to ridicule. Many claimed that what he had observed was in fact a twin crystal. The head of the laboratory gave him a textbook of crystallography and suggested he should read it … All the commotion finally led his boss to ask him to leave the research group, as Shechtman himself recalled later.”
And the most influential twin proponent at that time was Nobel laureate Linus Pauling. I consider the late chemist to be one of the greatest scientists alive then. The twin theory or model explains the experimental data by “twinning” or the interpenetration of two – at least – separate crystals. It is a well known phenomenon that can lead to very strange diffraction patterns. I heard Pauling give a talk on his twinning theory that I found absolutely convincing. But then, I was a fan. Pauling later had to amend his initial twinning model, but by that time the evidence had mounted – from all over the world – that the quasi-crystal phenomenon could not be explained simply by twinning.
Upon first making his observation, Shechtman reports saying to himself: “Eyn chaya kazo” (Hebrew for: “There can be no such creature”). No doubt he realized the heat he would take for reporting this discovery.
מזל טוב, Professor Shechtman.
This piece was originally posted on the Chronicle of HIgher Education Brainstorm Blog and is used with permission.
Figure used with permission of the University of Minnesota Bioethics Center.
I didn’t want to attend this conference because I knew that it would be difficult and painful. Like having your wisdom teeth pulled without anesthesia.
As my colleague, bioethicist Carl Elliot, put it: “Only 16 percent of academic health centers in this country will pay the medical bills for research subjects who are injured in clinical trials. None will pay for lost wages and suffering. And an ethicist is arguing that we all have a duty to sign up for these trials? Give me a break.”
But Carl was not able to attend this conference and I knew that Mary Weiss, the mother of Dan Markingson, would be there. Her son died in connection with a clinical trial at the University of Minnesota that has become notorious. I wanted to offer moral support. I met her – for the first time – before the start of the conference. She seemed in control, and we had a pleasant conversation, but I was concerned. After the first talk, on the pro side, she had to leave. I could understand why.
My original intention was to try to present a dispassionate description here of the pros/cons of the question outlining the case made by each side. But I can’t. At first I was offended that my university would put on such a conference given our terrible record with clinical trials in the past. It seemed hypocritical. But in retrospect, I thank the Center for Bioethics for broaching the subject. During the conference most of the points that needed to be made came out. Professor Joan Liashenko did the heavy lifting of organizing and running the conference.
I was particularly impressed by two African-American women who persistently questioned the claim that treating research participation as a moral obligation would actually help the minority community. Henrietta Lacks came up during the discussion. I later learned that one of these women is a bioethicist and the other the president of the Minnesota Black Nurse’s Association.
Which brings me to the first problem I have with the title proposition. Cui bono? And I maintain that the answer is overwhelmingly the pharmaceutical industry. This proposition finds support in the Lysaught presentation cited below.
But what really frosted me was the “moral obligation” business. Thou shalt not steal, thou shalt not kill, thou shalt not covet thy neighbor’s wife, thou shalt participate in clinical research?
The argument that it’s just like paying taxes or giving to charity seems absurd to me. As one of the participants put it, the consequences of paying taxes are not nearly as great as losing one’s life, or being blinded. And for what? Mostly to justify supposedly new clinical therapies for pharma?
And as for charity… Most of us believe, even if we don’t believe in a God, that we are our brother’s and sister’s keepers. When we give to charity, if we are so inclined, we can do a little investigation. We can find, if we wish, something about the percent of money that actually goes to use in a charity and how much goes to administration.
Most patients are not capable of making scientific judgments about whether a clinical trial is worthwhile. Many doctors and people who sit on institutional review boards are not. To claim that people should risk themselves, out of beneficence, to participate in a clinical trial is unreasonable. Certainly to declare it to be a moral obligation is wrong.
I was upset by the use of the term “moral obligation” because I think this means something far beyond “this would be a good idea.” I don’t think there is support for the proposition in the works of, for example, Kant or John Stuart Mill. But these arguments are dense and not easily capsulized for this forum.
I did find a wonderful talk by Professor Susan Wolf of the University of North Carolina, who gave the Frumke lecture at NYU entitled: “Moral Obligations and Social Commands.” This talk examines the concept of what a moral obligation is and gives examples. To claim that participation in research is a moral obligation does not seem to pass the Wolf Test. This outstanding lecture is available in hard copy here and even, mirabile dictu, on YouTube.
It was an exhausting day. Certainly caused a Brainstorm. I drove one of the speakers to the airport and came home. Took three beers to return to earth.
This piece originally appeared in the Chronicle of Higher Education. For those interested in more details, that version includes some references and links to the slides used by the conference speakers.
What Have We Learned From Bachmann’s Recent Gardasil/HPV Eruption?
Being a scientist makes spontaneous blogging on some topics problematic. A couple of weeks ago, Michele Bachmann made the unsupported claim that HPV vaccination led to “mental retardation.”
At the time two bioethicists— professors Steve Miles at the University of Minnesota and Art Caplan at the University of Pennsylvania—called out Bachmann and challenged her to provide evidence in support of her claim. Miles was first and offered to contribute $1,000 to a charity of her choice. Caplan upped the ante by $10,000. The offer expired with no response from Bachmann. Some right-wing luminaries, including Rush Limbaugh and Ed Morrissey, also came down hard on Bachmann for this claim.
1. Bachmann is not fit to be president.
Since I am interested in biological structure, I wanted to look a little more into the science of the HPV vaccines. Fascinating. Proteins from a variety of human papilloma viruses are produced by genetic engineering. The menu includes viruses that lead to cervical cancer as well as genital warts and other baddies. Such vaccines are a scientific tour de force. I also learned that the adjuvant used to make the vaccine contains aluminum. An adjuvant makes a vaccine more effective for reasons that are not crystal clear. It is possible that this adjuvant is responsible for the pain of injection experienced by those vaccinated.
2. A lot of good and nontrivial science has gone into this vaccine. Producing it is expensive.
Which leads into the final lesson. Or at least into a discussion of what makes the HPV/Gardasil controversy not simply a soundbite matter.
I need to give all credit to Alison Bass for calling this fact to my attention in her excellent essay “Coverage of Rick Perry’s vaccine misadventure misses the point.”
The problem is that the public health benefits of providing HPV vaccines to relatively affluent children may not make a lot of financial sense. Merrill Goozner has explored this idea in his post: “The Gardasil Hustle.”
As Bass points out: “Merck itself estimated it would cost $1.4- to $1.6-billion to immunize young girls from the disease, which can be picked up fairly easily (and much more cheaply) with regular pap smears.”
The distribution of cervical cancer is loaded heavily against the poor. The highest incidences may be found in African-American women and in white women living in Appalachia (see Cancer Health Disparities).
The poor are either uninsured or cannot afford Pap smears.
It may make more sense to use the money spent on HPV vaccinations for Pap smears for poor women who cannot afford them.
There is a lot of money on the table here. The Web is a nightmare for a truth seeker. You can find people claiming that HPV is more cancer causing than cigarettes or that the HPV vaccine is contaminated with HPV DNA. And it is sometimes difficult to know what to make of some of these Web sites. They look plausible. Some are even written by medical doctors, and some doctors put links to them in their tweets. What is the average parent in search of information to do? I’ll post some thoughts on this in the future.
Endnote: Thanks to Alison Bass for her always thought-provoking work.