Bob Ortega, our February Sidney Award-winner for his expose of a faulty HPV test, has another blockbuster story on women’s health.

U.S.-funded researchers testing a low-tech alternative to pap smears followed thousands of poor Indian woman to see if they developed cervical cancer, but they didn’t screen them to catch the disease early, they just waited to see if they’d get sick:

For more than 12 years, as part of two massive U.S-funded studies in India, researchers tracked a large group of women for cervical cancer but didn’t screen them, instead monitoring them as their cancers progressed. At least 79 of the women died.

One study, funded by the National Cancer Institute, did not adequately inform more than 76,000 women taking part about their alternatives for getting cervical-cancer screening; and those women did not give adequate informed consent, according to the Office of Human Research Protection, part of the U.S. Department of Health and Human Services.

The other study, funded by the Gates Foundation, is under review by the Food and Drug Administration, according to Kristina Borror, the OHRP’s director of compliance oversight. That study has raised similar concerns regarding 31,000 women who were tracked but not routinely screened or treated for cervical cancer.

Both studies continue today, though researchers for both told The Arizona Republic they have begun to offer screening to the women. [AR]

The subjects were uneducated women from the slums of Mumbai. The study was designed to determine whether diluted vinegar douches are an effective, low-tech screening test for cervical cancer. Abnormal tissue turns white in response to the acid.

Basically, women in the experimental groups got the test. Women in the control groups were told they could get HPV screening on their own, but they weren’t screened. Health care workers visited them to ask if they’d developed any symptoms of cervical cancer. Note that cervical cancer doesn’t usually cause symptoms until the disease is far advanced. The more advanced the cancer, the worse the patient’s odds of survival.

By 2009, the researchers had reason to believe the test was working. The vinegar seemed to be revealing abnormal cells, but the researchers felt they needed to keep the study going to show a statistically significant difference in cervical cancer rates between the experimental and control groups.

In 2011, an oversight body found that the National Cancer Institute-funded study had not obtained proper informed consent from their subjects and had not educated them properly about how to seek screening on their own. The researchers argued that the control group subjects were no worse off than they would have been if they hadn’t participated in the trial because most poor women in Mumbai don’t get cervical cancer screenings anyway.

It’s irrelevant whether the women in the control groups were worse off than they would have been. Control groups of this type were probably unnecessary in the first place. Cervical cancer researchers in many other developing countries reject the unscreened control group design. They have other ways to measure the efficacy of their tests.

At this point, the medical consensus is that any reliable form of cervical cancer screening is better than nothing. If the vinegar test accurately identifies cancers that would have otherwise gone unnoticed until much later, that’s proof that it works better than no screening. We don’t have to wait for unscreened women to get sick and die to prove the point.

A cancer screening trial with an unscreened control arm would never be allowed in the United States. Ortega quotes researchers who attempt to justify their laissez-faire approach by claiming that Western principles of research ethics, like informed consent, don’t apply to women in the slums of Mumbai. No doubt it’s more difficult to obtain informed consent for medical care from subjects who have little formal education, but that doesn’t imply that it’s any less important. Ortega’s reporting shows that the researchers didn’t even do the bare minimum.

It’s a twisted logic that says it’s okay to treat someone worse because they’re already so badly off.

[Photo credit: A slide from an HPV test, euthman, Creative Commons.]

Two weeks ago in Canarsie, a group of Cablevision workers took advantage of their company’s famous “open-door” management policy by stopping by a vice president’s office at the beginning of their shift. They wanted to talk about the future of their union. The technicians had voted to join the Communications Workers of America nine months prior, but contract talks were dragging on, and they wanted some assurance that the company was negotiating in good faith and not just trying to break the union.

The VP kept them waiting for 40 minutes and then fired them all on the spot, Michael Powell reports:

They waited for 20 minutes to talk, then 20 more. La’kesia Johnson, 44, grew restless and walked to the front office. A manager told her to go back inside. Then the vice president walked in and asked, essentially: Who’s supposed to be working now?

Every worker, 22 in all, raised a hand.

“Ladies and gentlemen,” the vice president said, according to multiple accounts, “I am sorry to tell you that you’ve all been permanently replaced.”

“I said, ‘Whaaat?’ ” Ms. Johnson says. “Replaced? You just fired us? You don’t even know what we want.”

Ms. Johnson says the vice president looked at her and stated: I don’t care what you want. [NYT]

Cablevision claims that the workers were fired because they refused to go to work, a claim that is undermined by the fact that the workers loaded up their trucks with all the supplies they needed for their shift before they went to see the VP.

The Village Voice reports that about 50 workers initially showed up to meet with vice president Rick Levesque, but that most left to go back to work when they realized he had no intention of meeting with them, but a core group of activists was invited stay, according to the Voice:

As the technicians were leaving, Levesque approached Adams, his fellow shop stewards and a few other technicians to meet with him inside the site’s conference room.

“He says he has time all of a sudden to speak with us. So, we sit down, and we’re expecting to speak with him right then and there. And, he spends another 20-25 minutes before he comes back,” Adams says.

When he came back the workers were informed that they’d been permanently replaced for staging an unauthorized meeting and refusing to work. Five of the fired workers, who were rehired last week, were already in the middle of jobs when they were called back to be fired for “refusing” to work. [VV]

All of the major mayoral candidates in New York are supporting the Cablevision workers. The union and the fired technicians were in Albany this week urging state legislators to investigate Cablevision’s labor practices.

[Photo credit: A cable technician, for illustration, jDevaun, Creative Commons.]

This New York Times editorial pulls no punches. It bluntly states what everyone knows, but what some have been too delicate to spell out in so many words, namely, that the Republicans are using the filibuster to strangle Consumer Financial Protection Bureau:

The bureau cannot operate without a director. Under the Dodd-Frank law, most of its regulatory powers — particularly its authority over nonbanks like finance companies, debt collectors, payday lenders and credit agencies — can be exercised only by a director. Knowing that, Republicans used a filibuster to prevent President Obama’s nominee for director, Richard Cordray, from reaching a vote in 2011. Mr. Obama then gave Mr. Cordray a recess appointment, but a federal appeals court recently ruled in another case that the Senate was not in recess at that time because Republicans had arranged for sham sessions.

That opinion, if upheld by the Supreme Court, is likely to apply to Mr. Cordray as well, which could invalidate the rules the bureau has already enacted. The president has renominated Mr. Cordray, but Republicans have made it clear that they will continue to filibuster, using phony arguments to keep the agency from operating. [NYT]

Forty-three Senate Republicans wrote a letter to the president threatening to filibuster his nominee until “major structural changes” are made to the CFPB. Needless to say, the Republicans are holding out for structural changes that would cripple the bureau. In its short life so far the CFPB has won an $85 million settlement against American Express for deceptive marketing practices, cracked down on some predatory mortgage-lending tactics, and opened an investigation into dubious credit card marketing on college campuses. Some critics say the bureau hasn’t done enough, but the Republicans want to see it doing even less.

[Photo credit: 401(k) 2013, Creative Commons.]

In an op/ed entitled “The Case for Torture,” Will Saletan writes that a recent panel discussion with former CIA officials “shook up [his] assumptions about the interrogation program” and “might shake up yours, too.” He doesn’t say what he thought before he watched Michael Hayden, Jose Rodriguez, and John Rizzo justify torture, but he goes on to sympathetically enumerate 13 arguments the panelists made. The invited inference is that these are the arguments that changed Saletan’s mind, and that the change was to make him more sympathetic to torture. 

Saletan shamelessly exploits the ambiguity between “the case some other people made for torture” and “the case I’m making for torture.” The defense that he’s just reporting what the panelists said is ridiculous. He’s not a stringer for the AP. This column appears in the op/ed section.

Saletan structures the column to give himself maximum cover. He starts out by saying that the AEI panel changed his mind, then he enumerates the panelists’ arguments, and in the final section he mouths some platitudes about how we should all be willing to reexamine our moral positions.

If it is reporting, it’s bad reporting. Saletan takes the claims of the most senior architects of torture at face value. These guys know more about the program than almost anyone, so we can’t afford to reflexively discount what they say about it, if we want to understand it, but let’s keep in mind that they are professional deceivers who, at best, skirted the law and at worst broke it. They see themselves as fighting an ongoing war and they know that what they say now will have implications for how that war goes. They have every reason to lie about what they did and how they did it.

Saletan blithely ignores basic critical questions like: If torture was so effective, why didn’t we catch Bin Laden during the height of the torture era? Why did it take over a decade?

He comes across as utterly credulous, producing lines like: “So, for what it’s worth, there were internal checks on the practice, at least because the CIA would be politically accountable for what its interrogators did.” Right. That’s why Jose Rodriguez deleted all those interrogation tapes.

For minimum journalistic due diligence, Saletan should have tried to square the claims of the panelists against other available evidence–like the testimonies of former detainees, their lawyers, defectors from the military and the intel communities, academic and journalistic experts, and so on. These sources have their own vested interests, but a responsible journalist tries to sort through the competing claims and acknowledges the limits of the available evidence. 

Saletan reveals a shaky grasp of the moral and empirical issues at stake. He’s impressed with the panelists’ bizarre claim that their brand of torture was somehow more acceptable because they used it to crush the detainees’ will to resist rather than to extract information through sheer physical agony. Practically speaking, torture is an ineffective means of extracting truth in the moment because the target will say anything to stop the pain. However, it’s an unproven assumption that utterly crushing a detainee’s spirit is a more reliable means to the truth than non-coercive interrogation. You might end up with a detainee who will say anything he thinks you want to hear because you’ve severed his grip on reality, or not say anything intelligible because you’ve pushed him into stupor, delirium, or intractible paranoia–as opposed to a detainee who will say anything to make you stop pouring water into his sinuses. To suggest that it’s more ethical to push an individual to psychological collapse makes a mockery of ethics.

Saletan resorts to pompous weasel words when he lacks the courage of his convictions. He’s too timid to come out and say that he approves of the “enhanced interrogation program” as it was used in the hunt for Bin Laden, but he keeps tipping his hand with the language he uses to describe the panelists’ arguments.

For example, he writes that the panelists “scorned the delusion that these methods hadn’t produced vital information.” By using the word “delusion” instead of “belief” or “claim,” Saletan implies that the pro-torture contingent is right without having to provide any evidence for their dubious claim that torture produced vital information that couldn’t have been gotten any other way. According to Saletan, the panelists “trashed the Obama-era conceit that we’re a better country because we’ve scrapped the interrogation program,” the word “conceit” implies that Obama is wrong or dissembling.

Saletan concludes by saying that “even when we decide that brutal interrogation methods are justified,” we should reexamine our prejudices so that we stop brutalizing people “when the reasons no longer suffice.” That’s when we decide, not if we decide, according to Saletan. That construction seems to allow for wrong decisions, but by adding “when the reasons no longer suffice,” Saletan is implying that sometimes the reasons for torture do suffice. If that’s what he really thinks, he should come out and say so instead of laundering his opinions through the pronouncements of AEI panelists.

[Photo credit: Truthout.org, Creative Commons.]