Chapter 2 from my book found posted here as a pdf and on the Springer International website http://tinyurl.com/muj8jyn. While not posted here, the table of contents may also be downloaded at the Springer site. Have you pre-ordered your copy?
Chapter 2 of my Systems Thinking and Policy Book
MBF
My book now available at http://link.springer.com . This method will require library license. Paperback and e-book coming soon for the rest of us. Please spread the word of #orgcomplexity. I am so glad that the book is now widely available. @SpringerPBH @MaceyLHenderson
Due for release late 2014- early 2015
It is Official- My systems thinking/policy book has a release date of December 2014- Pre-order print or ebook @ Amazon and Springer website http://lnkd.in/bun2Dvs. My book is popping up with independent book vendors as well.Choose the vendor that suits you! No vendor endorsement implied.
Just in time for holiday giving or course book selection!
@mbattlefisher
Using The United States’ The Family Smoking and Prevention Act (Public Law 111-31) as an example, complexity is inherent to anti-tobacco policy and how unexpected factors emerge once such a divisive policy is enacted. Passed during President Barack Obama’s first administration, The Family Smoking and Prevention Act (Public Law 111-31) became the most sweeping regulatory support in combatting a leading cause of preventable death in the United States that have been scientifically linked to tobacco use. The Family Smoking and Prevention Act did not take away access to tobacco to consumers of age. Tobacco is sold legally, under the continued regulatory oversight from the Federal Food and Drug Administration. Newly ‘strengthened’ regulatory powers supplied by this act works to ensure the “safest” possible tobacco products sold to U.S. consumers using the most ethical forms of marketing to the public. Safe is certainly used loosely here. The sale of tobacco as ethical is another question. But tobacco is legal to use for those of age to use the product. What is allowed from a regulatory standpoint by this Act is targeting sales, marketing and distribution channels.
Upon maximization, the virtuous goal is to optimize the desired benefit of tobacco control policy, thereby saving lives and improving quality of life from morbidity and mortality related to tobacco use.
“This legislation will not ban all tobacco products, and it will allow adults to make their own choices…We know that even with the passage of this legislation, our work to protect our children and improve the public’s health is not complete.”, President Barack Obama during the signing of the Family Smoking Prevention and Tobacco Control Act (2009)
“Deliberate or orderly steps are not an accurate portrayal of how the policy process actually works. Policy making is, instead, a complexly interactive process without beginning or end.” (Lindblom & Woodhouse, 1993).
President Obama’s statement illustrates the depth and limitations of the powers of policy and portends systemic mess that could possibly ensure even under the most noble of intention. From his statement, we can take away that the following issues are central to the prescript of the law.
1. Increasing regulation of a legal product, in this case, tobacco.
2. Blocking tobacco advertisements from children within a specified distance of schools and parks.
3. Making flavored tobacco distribution illegal. Menthol is excluded from this ban.
4. All harmful chemicals must be fully disclosed to the smoker along with graphic fear appeals on the labelling.
5. Public Safety overrides autonomous actions of the consumer. Some elements of the society, such as children, require higher ethical safeguards which require the power of policy behind it.
Is an advertisement on the way home from the park that falls outside of the banned quadrant acceptable? By the letter of the policy, it is allowed. Is it ethical at the point of exposure to the ad or to the mere possibility of exposure to the marketing? Menthol is exempt from federal ban. Menthol would be a gustatory nightmare that does not leave a smoker’s breath or lungs minty fresh. I would rethink a pint of vanilla bean and menthol ice cream, but the immense popularity of the menthol flavor in tobacco does not require a sugar cone. It requires demand. Do we have enough room on the carton? It is going to have to be microscopic font and some gory images.
I am a never-smoker but that reality does coat my social and intellectual observations of the “smoker”. When I have stood behind someone purchasing tobacco, I have marveled at the specification given by the customer when requesting a cigarette. The customer recalls with exact precision of the colors on the box, the shelf location, and the nature of acrid, intoxicating smell wafting from the creases of the box.
Nope…Yes, the box right there on the second shelf next to the Ultra non-filtered. I want those menthol non-filtered buy one, get one. It will be debit card. And a lighter.
Cigarette smokers have been found to have very high levels of brand loyalty (see Dawes, 2013). The smoker knows the brand, down to the flavor, even recalling the specifications of the box that they want. At times, perhaps another perceived equivalent cigarette will do just this once and buy a comparable brand if the requested one is not available (Dawes, 2013). For others, not having their brand is a game breaker. Dawes (2013) in his analysis of U.S. cigarette consumer panel data uncovered the strong power of perception in cigarette branding.
1. A smoker that purchases high end cigarettes most likely will not lower the expectation of the quality perception by buying a generic brand.
2. If there is a female aesthetic on the box, men will not bite at all even when the call of nicotine gnaws. They will look for a cowboy or something testosterone driven in marketing appearance.
3. Price point does matter.
4. If you want overwhelming consumer loyalty, market to a smoker.
(Dawes, 2012)
But is packaging the end of the story? It is only one of parameters churning.
Voluntarily taking the smokes off of the shelves is a different animal altogether. What if a pharmacy decides to no longer sell tobacco which in 2014 was being tried? The smoker may choose to patronize a competing pharmacy that still sells the desired product. In order to offset the loss of sales in tobacco, what other measures will be set in place by the corporation to keep the smoker in their pharmacy a happy customer for other durable goods or leverage opportunities to bring in more new customers to offset the effects of losing smokers’ business? From a public health standpoint, good job for removing tobacco. From a business standpoint, will that smoker decide to move his prescriptions to a rival pharmacy? From a system dynamics view, a business move that diminishes returns is a negative feedback while increasing returns is positive (see Sterman, 2000). While there are standalone pharmacies that only dispense medication, many pharmacies double as quick convenience stores. A smoker is a goldmine. There will be medications on the horizon, if not filled already, to treat the morbidities related to smoking.
How can the tobacco removal spin work, really? Will the spiel from the CEO announcing the policy to remove the tobacco products lose resonance once the Twitter frenzy ensues farther diluting the intended corporate message. Once a message is viral on social media, the more removed the policy machine becomes and the message becomes more susceptible to distortion and emotion. Does the removal of tobacco tricked to higher prices across all products in order to make up for the projected loss of profit? Does a nonsmoker care about using a tobacco free business if he never bought or consumed the product at that time of service? What effect, in the long term, will removing tobacco from one chain have on tobacco related outcomes? Will other pharmacy chains follow suit? As you can see, these policy tentacles overlap and intertwine.
References
Dawes, John G., Cigarette Brand Loyalty and Purchase Patterns: An Examination Using US Consumer Panel Data (August 9, 2012). Available at SSRN: http://ssrn.com/abstract=2126951 or http://dx.doi.org/10.2139/ssrn.2126951.
Lindblom, Charles E. and Edward J. Woodhouse. 1993. The Policy Making Process, 3 Edition.Upper Saddle River, NJ: Prentice Hall.
Sterman, J. (2000). Business Dynamics-Systems Thinking and Modeling for a Complex World. Boston: The McGraw-Hill Companies.
FYI- FAMILY SMOKING PREVENTION AND TOBACCO CONTROL AND FEDERAL RETIREMENT REFORM (US Public Law 111-31)
http://www.gpo.gov/fdsys/pkg/PLAW-111publ31/pdf/PLAW-111publ31.pdf.
Bruce Wayne and his alter ego, Batman, is the epitome of dynamic contradictions.Not unlike Batman’s character struggles, character is built and questioned constantly, often without a law in sight. Since we are tied to people who talk to each other and make social gestures that have to be recognized, the allegory of the gestures of Batman will be used in the following pages to demonstrate how dynamic systems of trust and relationship were right in front of us all along.
As the alter ego of Bruce Wayne, Batman’s identity rests with his strong sense of citizenship with the inhabitants of Gotham City as well as his fixation for vengeance. After the untimely deaths of Bruce Wayne’s parents, his sole purpose was fixated on righting wrong his way. Heroes or, even more interesting counterparts, the anti-heroes in comics are hyper-real. I, the hero, am good, which is obvious by my fluttering cape with the symbol emblazoned on my pectorals. You, the villain, in body skimming spandex sans cape or even the run-of–the-mill town crook, are not good. The anti-hero is downright malevolent (or perhaps just clueless). The duelists compete in a “language of gestures” (Mead, 1938). To Mead, meaning in the world is made through signals and gestures as a kind of social behaviorism (Mead, 1938). The hero saves the world from ruin. The crowned hero takes a right to the kisser. The miscreant falls ungracefully off the cliff on the outskirts of the city. The physical nooks and crannies around Gotham City are incredibly unexpected and diverse, would you not agree? The hero often appears out of thin air. The villain plunders for power and perhaps less importantly material gain. The hero prevails is immediately absolved for throwing city property at said villain. What brought the hero to that place?
Mead (1938) related this idea of gestures to primarily verbal communication. However this idea can be broadened beyond the spoken word. The superheroes in the bout use verbal and physical fighting so as to “make the gestures (the) same”. The villain gets squashed to smithereens by before mentioned city property then hobbles alone to the dark lair to hatch the next scheme. The higher level of cognitive significance of communicating started with those fisticuffs. But mind you, Batman returns to the dank dark cave…alone to live with consequences of his actions.
Both hero and villain are tortured in levering heuristics that each in itself could wreak havoc with stability. Each side of the superhero ethical equations brings undeniable fervor and passion. Bruce Wayne was pushed by a strong drive to avenge. But do superheroes or we mere mortals work primarily off of emotion? Should policy view society as one of rationalized competition for limited resources or one where there is collaboration? For that matter, how should be view “communities of solution” in the same fashion? I do not remember Batman having a brewski in the Arkham Asylum with The Joker. But people tend to demonstrate an allegiance to a side (if only for appearances) to maintain social accord or to leverage advantage.
Any change called metachanges, such as a misplaced physical punch or even a faulty ethical decision, could have major repercussions on the already delicate balance of power. The crooks are transporting from the city dock outdated cathode televisions that conceal booty. Batman swoops down. Good prevails. Bad is defeated for now. But will that Gotham peace last or be the most beneficial in the long term? Does Batman’s moral center waver?
In part, policy must manage the social and ethical principles linked to the nature of these metachanges. Those in policy game realize all too well that the broader politicized arc is really a generalization of all those metachanges. Those metachanges, some perhaps deemed inconsequential or undiscovered, can have widespread dynamic changes on the larger social system. To that end, tackling these real world metachanges can lead to the large visible health payoff that society requires and expects resolution with their morning coffee. The villain is foiled and all is right in our Gotham until the same burgeoning health concern comes back on the top of the policy docket. Batman found the sweet spot briefly, retreating to his bunker wearing his dented Batsuit to the sage advice of his comrade, Alfred. Policymakers reenter the policy bunker, dodging the heuristics minefield, while shrouded by a porous cloak of political stability. The citizens of Gotham haunt them all in public health while some take a long drag on their cig to calm the nerves. It is back to the drawing board.
Reference:
Mead, George (1934) Mind, Self, and Society, ed. C.W. Morris (Chicago: University of Chicago Press)
I have actually been approached as to why I have not posted on Orgcomplexity as much in recent months.
There is actually a very good reason.
I am ready to announce that my single-authored book that brings systems thinking to health policy and ethics is under contract with Springer. It will be a part of the inaugural SpringerBriefs series in Public Health Ethics. I will keep everyone updated with the publication details in the next few months. The target for publication is mid-2014.
Thank you for supporting Orgcomplexity and I hope that you will continue to follow my book progress over the coming months.
All the best,
Michele Battle-Fisher
– Questions? Mail to info@erasmusobservatoryonhealthlaw.nl or hollen@bmg.eur.nl
http://www.erasmusobservatoryonhealthlaw.nl/summerschool2014/
Dr. Sigrid Fry-Revere, author of The Kidney Sellers
If you have been a dedicated follower of this blog, a common refrain has been the complexity inherent to ESRD and organ donation issues. I am honored to share an interview with Dr. Sigrid Fry-Revere (photo above), the Chairwoman and Founder of the Center for Ethical Solutions. Dr. Fry-Revere has enjoyed an extensive career in bioethics and health policy. I recently had the opportunity to ask Sigrid about her upcoming book, The Kidney Sellers, a book that chronicles her journey as the first Westerner to witness firsthand the Iran’s organ procurement system.
Orgcomplexity: Dr. Fry-Revere, thank you for sharing news of your new book with Orgcomplexity. Many may (or may not) be aware of how the need for procurement of organs in the United States. Would you share how bad the organ shortage in US and abroad is?
Dr. Fry-Revere: In the United States there are 100,000 or more people waiting for kidneys. Worldwide 90% of those who need life-saving organs need kidneys. In the United States only 15% of those waiting get a transplant. The rest wait and get sicker and sicker on dialysis and most die without getting a transplant. The longer on dialysis, the less likely a kidney transplant will work even if the person gets one. The average wait in the U.S. is five years.
Orgcomplexity: Why aren’t there enough cadaver kidneys? Is living donation the answer?
Dr. Fry-Revere: Only approximately 1% of people who die in the United States die under conditions where organs can be harvested. Most are too sick, too old, or die too far from the hospital for organs to be usable. Even if every organ that is even conceivably usable were harvested (Presumed Consent), we would only increase our kidney supply by less than 30,000 kidneys, and we need 100,000 or more. Note 30,000 is an optimistic figure because the more marginal the conditions under which a kidney is harvested the lower the conversion rate — the lower the chances that it will be transplantable even if harvested or that the transplant will succeed.The world’s first transplants were with living donors and in the last 30 years in the United States anywhere from a third to half of all kidney transplants were done with kidneys from living donors. For example, the 30,000 assumes an 82% conversion rate, but when the Washington D.C. Transplant Community (where I’m the ethicist for their Organ and Tissue Advisory Committee) makes efforts to maximize the number of organs harvested by harvesting from older and sicker patients, the conversion rate drops by 10% or more. So the yield of potentially usable cadaver kidneys is difficult to pin down.
Orgcomplexity: I have heard about a black market in organs. Is that true? What is the black market in kidneys?
Dr. Fry-Revere: A black market is an illegal market where anyone involved is punishable by fines or jail if they participate and/or there are is no legal infrastructure or laws to deal with disputes when contracts are made. A 2009 United Nations report estimates that 10% of all transplants are illegal black-market transplants with most of the purchasers being from western countries in North America and Europe while most sellers are from developing nations. As a result there is horrific exploitation of impoverished people by wealthy Westerners who don’t have friend or family who can donate and don’t want to brave the waiting list. As a result donors often don’t get the money they are promised, suffer crude and indignant surgical procedures, and often suffer or die for lack of adequate post-operative care.
Orgcomplexity: One might ask why you would want to go to Iran as a subject for your book.
Dr. Fry-Revere: I would rather go to the Bahamas but Iran is the only country in the world with a legalized market in kidneys. I was in Iran for nearly two months. I visited six major cities, each of which had a transplant program. I interviewed kidney buyers and sellers, doctors, the middlemen who arrange kidney sales, and an Ayatollah.
Orgcomplexity: Thank you so much for sharing news of this great work. Could you share how someone might be able to find your book?
Dr. Fry-Revere: The book website is on the CES website. www.TheKidneySellers.com. It is due to come out on February 1, 2014 in hardback. All author royalties are going to the SOS (Solving the Organ Shortage) project of the Center for Ethical Solutions. You can visit www.ethical-solutions.org/projects/sos/ for more information about The Center and this project. Thank you for this opportunity to reach the systems community.
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Interested in Orgcomplexity’s take on ESRD and its systemic issues? Check out the hot links for past Orgcomplexity blogs on the subject!
Disclosure- Orgcomplexity’s founder, Michele Battle-Fisher, is on the Board of Directors of the Center for Ethical Solutions. Michele Battle-Fisher does not profit in her affiliation with CES. Michele Battle-Fisher or Orgcomplexity do not in any way profit directly from the sale of this book.
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