— Three National Academies Recent Studies

An Op-Ed Piece; doc’s eclectic views November 1, 2011

By Harry Babad, © Copyright 2011, All Rights Reserved  — Used under the Creative Commons Attribution-ShareAlike License


Introduction

As is my want, I periodically check the National Academies Press web pages for workshop notes/articles/reports that appeal to me, not as nuclear waste and energy expert. Rather I explore the various issues at times only ripples and at times tidal waves related to public policy in both American society and that of the world.

Hence this Op-Ed piece. Herein I COPY the prefaces or abstracts from three reports I found both distress and challenging. Unusual for me, I do not editorialize on them, that’s up to you, the reader. I do however highlight sections that made a deep impression on me by either underlining the (if short) or by enclosing them in a text box. I also could not resist my genetic editors syndrome so I split a few sentences in two, or added in italics, a linking word or two. Remember, my stuff is in italics.

Also the graphics are my idea, the NRC reports a captained extensive tables and figures, good technical stuff, but are not into Flesch–Kincaid readability test  levels for their narratives or illustrations. But my friends in the academies will not disinherit me because its all for an educational purpose. _        Doc.

…Read on!

A Renewable Biofuel Standard — America’s Quandary

Scientific Legal Evidence Revisited – Reference Manual on Scientific Evidence: Third Edition

Essential Health Benefits — Balancing Coverage & Costs

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Setting a Biofuels Renewable Fuel Standard

— Choosing an alternative, an all American Quandary [A NRC Study of the Potential Economic and Environmental Effects of U.S. Biofuel Policy]

“In the United States, we have come to depend upon plentiful and inexpensive energy to support our economy and lifestyles. In recent years, many questions have been raised regarding the sustainability of our current pattern of high consumption of nonrenewable energy and its environmental consequences. Further, because the United States imports about 55 percent of the nation’s consumption of crude oil, there are additional concerns about the security of supply. Hence, efforts are being made to find alternatives to our current pathway, including greater energy efficiency and use of energy sources that could lower greenhouse gas (GHG) emissions such as nuclear and renewable sources, including solar, and (also their) environmental consequences of increasing biofuels production. The statement of task asked this committee to provide “a qualitative and quantitative description of biofuels currently produced and projected to be produced by 2022 in the United States under different policy scenarios …

“The United States has a long history with biofuels. Recent interest began in the late 1970s with the passage of the National Energy Conservation Policy Act of 1978, which established the first biofuels subsidy, applied in one form or another to (mostly) corn-grain ethanol since then. The corn grain ethanol industry grew slowly from early 1980s to around 2003. From 2003 to 2007,ethanol production grew rapidly as methyl tertiary butyl ether was phased out as a gasoline oxygenate and replaced by ethanol. Interest in providing other incentives for biofuels increased also because of rising oil prices from 2004 and beyond. The Energy Independence and Security Act of 2007 established a new and much larger Renewable Fuels Standard and set in motion the drive towards 35 billion gallons of ethanol-equivalent biofuels plus 1 billion gallons of biodiesel by 2022. This National Research Council committee was asked to evaluate the consequences of such a policy; the nation is on a course charted to achieve a substantial increase in biofuels, and there are challenging and important questions about the economic and environmental consequences of continuing on this path.

The National Research Council committee brought together expertise on the many dimensions of the topic. In addition, we called upon numerous experts to provide their perspectives, research conclusions, and insight. Yet, with all the expertise available to us, our clearest conclusion is that there is very high uncertainty in the impacts we were trying to estimate. The uncertainties include essentially all of the drivers of biofuel production and consumption and the complex interactions among those drivers: future crude oil prices, feedstock costs and availability, technological advances in conversion efficiencies, land-use change, government policy, and more.

“The U.S. Department of Energy projects crude oil price in 2022 to range between $52 and $177 per barrel (in 2009 dollars), a huge range. There are no commercial cellulosic biofuels plants in the United States today. Consequently, we do not know much about growing, harvesting, and storing such feedstocks at scale. We do not know other than for ethanol how well the conversion technologies will work nor what they will cost. We do not have generally agreed upon estimates of the environmental or Green House Gases [GHG] impacts of most biofuels. We do not know how landowners will alter their production strategies. The bottom line is that it simply was not possible to come up with clear quantitative answers to many of the questions. What we tried to do instead is to delineate the sources of the uncertainty, describe what factors are important in understanding the nature of the uncertainty, and provide ranges or conditions under which impacts might play out.

“Under these conditions, scientists often use models to help understand what future conditions might be like. In this study, we examined many of the issues using the best models available. Our results by definition carry the assumptions and inherent uncertainties in these models, but we believe they represent the best science and scientific judgment available.

“We also examined the potential impacts of various policy alternatives as requested in the statement of work. Biofuels are at the intersection of energy, agricultural, and environmental policies, and policies in each of these areas can be complex. The magnitude of biofuel policy impacts depends on the economic conditions in which the policy plays out, and that economic environment (such as GDP growth and oil price) is highly uncertain. Of necessity, we made the best assumptions we could and evaluated impacts contingent upon those assumptions. Biofuels are complicated.

“Biofuels are controversial. There are very strong advocates for and political supporters of biofuels. There are equally strong sentiments against biofuels. Our deliberations as a committee focused on the scientific aspects of biofuel production—social, natural, and technological. Our hope is that the scientific evaluation sheds some light on the heat of the debate, as we have delineated the issues and consequences as we see them, together with all the inherent uncertainty.”

Why No Conclusions or Recommendations? — “The statement of task calls on the committee to refrain from recommending policies but to provide an objective review of the policy instruments available, including an assessment of the strengths and weaknesses of each in affecting long-term trends in transportation energy use and emissions. Because of the multitude of ways in which individual policy instruments can be designed, targeted, and applied, it was not possible to examine all of their possible variations and outcomes for a sector as large and diverse as U.S. transportation. For example, how fast and by how much fuel taxes or vehicle efficiency standards are raised will profoundly influence the relative prospects of such options for implementation and their effects on energy use and emissions and on other areas of interest to policy makers such as transportation safety, the environment, and the economy. This study is not a modeling exercise aimed at projecting and quantifying the effects of many policy instruments, each designed and structured in alternative ways and applied across one or more modes. The more realistic study goal is to compare the main types of policy options with respect to the main energy- and emissions-saving responses they induce and the challenges and opportunities they present for implementation.”

There is much in this report to stretch you mental muscles. Too, often what we read is distorted by either the silver bullet or golden goose syndrome or by WIIFT. As is usual with NAS reports, there are occasional places where I differ from the conclusions of this consensus report; but consensus is just that — not perfect, just hopefully workable. Indeed where panel members are friends or colleagues, I’ve often argued particular points with them. However, over-all the reports are a very good source of information.

National Academy of Science-National Academies Press <2011> The PDF download is free!  PREPUBLICATION COPY – document is subject to editorial changes only.

Biofuel – Wikipedia, 2011 — http://en.wikipedia.org/wiki/Biofuels

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Scientific Legal Evidence Revisited – Reference Manual on Scientific Evidence: Third Edition

On many occasions I have gripped about courts treatment of scientific evidence and at times written in praise of revising the tort system with the wider scale implementation science courts using well-trained certified peer accredited combinations legal experts and scientists, to assist the judge. Cases would not go to juries until the underlying scientific evidence had been evaluated. Why — just on example,  chrysotile based asbestos fibers are relatively low in toxicity so should not be painted with the same brush as Amphibole asbestos.

 This NAP document sings the songs I love to hear; belief and science have their own place.

Only then could a case enter the fault finding juried phase. I would much rather give jury applicants tests in scientific methodology and broad knowledge, but I suspect very few potential jurors would pass such a test. Yes, I hear the screams from lawyers deprived of their cut, civil libertarians and educators.

The NRC Report Summary

“Supreme Court decisions during the last decade of the twentieth century mandated that federal courts examine the scientific basis of expert testimony to ensure that it meets the same rigorous standard employed by scientific researchers and practitioners outside the courtroom. Needless to say, this requirement places a demand on judges not only to comprehend the complexities of modern science but also to adjudicate between parties’ differing interpretations of scientific evidence.

“Science, meanwhile, advances. Methods change, new fields are born, new tests are introduced, the lexicon expands, and fresh approaches to the interpretation of causal relations evolve. Familiar terms such as enzymes and molecules are replaced by microarray expression and nanotubes; single-author research studies have now become multi-institutional, multi-author, international collaborative efforts. No field illustrates the evolution of science better than forensics.

“The evidence provided by DNA technology was so far superior to other widely accepted methods and called into question so many earlier convictions that the scientific community had to reexamine many of its time-worn forensic science practices. Although flaws of some types of forensic science evidence, such as bite and footprint analysis, lineup identification, and bullet matching were recognized, even the most revered form of forensic science—fingerprint identification—was found to be fallible. Notably, even the “gold standard” of forensic evidence, namely DNA analysis, can lead to an erroneous conviction if the sample is contaminated, if specimens are improperly identified, or if appropriate laboratory protocols and practices are not followed.

“Yet despite its advances, science has remained fundamentally the same. In its ideal expression, it examines the nature of nature in a rigorous, disciplined manner in, whenever possible, (in) controlled environments. It still is based on principles of hypothesis generation, scrupulous study design, meticulous data collection, and objective interpretation of experimental results. As in other human endeavors, however, this ideal is not always met. “Feverish competition between researchers and their parent institutions, fervent publicity seeking, and the potential for dazzling financial rewards can impair scientific objectivity. In recent years we have experienced serious problems that range from the introduction of subtle bias in the design and interpretation of experiments to overt fraudulent studies. In this welter of modern science, ambitious scientists, self-designated experts, billion dollar corporate entities, and aggressive claimants, judges must weigh evidence, judge, and decide.

“As with previous editions of the Reference Manual, this edition is organized according to many of the important scientific and technological disciplines likely to be encountered by federal (or state) judges. We wish to highlight here two critical issues germane to the interpretation of all scientific evidence, namely issues of causation and conflict of interest. Causation is the task of attributing cause and effect, a normal everyday cognitive function that ordinarily takes little or no effort. Fundamentally, the task is an inferential process of weighing evidence and using judgment to conclude whether or not an effect is the result of some stimulus. Judgment is required even when using sophisticated statistical methods.

“Such methods can provide powerful evidence of associations between variables, but they cannot prove that a causal relationship exists. Theories of causation (evolution, for example) lose their designation as theories only if the scientific community has rejected alternative theories and accepted the causal relationship as fact. Elements that are often considered in helping to establish a causal relationship include predisposing factors, proximity of a stimulus to its putative outcome, the strength of the stimulus, and the strength of the events in a causal chain.

“Unfortunately, judges may be in a less favorable position than scientists to make causal assessments. Scientists may delay their decision while they or others gather more data. Judges, on the other hand, must rule on causation based on existing information. Concepts of causation familiar to scientists (no matter what stripe) may not resonate with judges who are asked to rule on general causation (i.e., is a particular stimulus known to produce a particular reaction) or specific causation (i.e., did a particular stimulus cause a particular consequence in a specific instance). In the final analysis, a judge does not have the option of suspending judgment until more information is available, but must decide after considering the best available science. Finally, given the enormous amount of evidence to be interpreted, expert scientists from different (or even the same) disciplines may not agree on which data are the most relevant, which are the most reliable, and what conclusions about causation are appropriate to be derived.

“Like causation, conflict of interest is an issue that cuts across most, if not all, scientific disciplines and could have been included in each chapter of the Reference Manual. Conflict of interest manifests as bias, and given the high stakes and adversarial nature of many courtroom proceedings, bias can have a major influence on evidence, testimony, and decision making. Conflicts of interest take many forms and can be based on religious, social, political, or other personal convictions. The biases that these convictions can induce may range from serious to extreme, but these intrinsic influences and the biases they can induce are difficult to identify. Even individuals with such prejudices may not appreciate that they have them, nor may they realize that their interpretations of scientific issues may be biased by them.

“Because of these limitations, we consider here only financial conflicts of interest; such conflicts are discoverable. Nonetheless, even though financial conflicts can be identified, having such a conflict, even one involving huge sums of money, does not necessarily mean that a given individual will be biased. Having a financial relationship with a commercial entity produces a conflict of interest, but it does not inevitably evoke bias. In science, financial conflict of interest is often accompanied by disclosure of the relationship, leaving to the public the decision whether the interpretation might be tainted. Needless to say, such an assessment may be difficult. The problem is compounded in scientific publications by obscure ways in which the conflicts are reported and by a lack of disclosure of dollar amounts.

“Judges and juries, however, must consider financial conflicts of interest when assessing scientific testimony. The threshold for pursuing the possibility of bias must be low. In some instances, judges have been frustrated in identifying expert witnesses who are free of conflict of interest because entire fields of science seem to be co-opted by payments from industry. Judges must also be aware that the research methods of studies funded specifically for purposes of litigation could favor one of the parties. Though awareness of such financial conflicts in itself is not necessarily predictive of bias, such information should be sought and evaluated as part of the deliberations.

“The Reference Manual on Scientific Evidence, here in its third edition, is formulated to provide the tools for judges to manage cases involving complex scientific and technical evidence. It describes basic principles of major scientific fields from which legal evidence is typically derived and provides examples of cases in which such evidence was used. Authors of the chapters were asked to provide an overview of principles and methods of the science and provide relevant citations.

“We expect that few judges will read the entire manual; most will use the volume in response to a need when a particular case arises involving a technical or scientific issue. To help in this endeavor, the Reference Manual contains completely updated chapters as well as new ones on neuroscience, exposure science, mental health, and forensic science. This edition of the manual has also gone through the thorough review process of the National Academy of Sciences.

“As in previous editions, we continue to caution judges regarding the proper use of the reference guides. They are not intended to instruct judges concerning what evidence should be admissible or to establish minimum standards for acceptable scientific testimony. Rather, the guides can assist judges in identifying the issues most commonly in dispute in these selected areas and in reaching an informed and reasoned assessment concerning the basis of expert evidence. They are designed to facilitate the process of identifying and narrowing issues concerning scientific evidence by outlining for judges the pivotal issues in the areas of science that are often subject to dispute.

“Citations in the reference guides identify cases in which specific issues were raised; they are examples of other instances in which judges were faced with similar problems. By identifying scientific areas commonly in dispute, the guides should improve the quality of the dialogue between the judges and the parties concerning the basis of expert evidence. In our committee discussions, we benefited from the judgment and wisdom of the many distinguished members of our committee, who gave time without compensation.”

http://www.nap.edu/catalog.php?record_id=13163

The PDF download is free!  PREPUBLICATION COPY – document is subject to editorial changes only.

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Essential Health Benefits — Balancing Coverage & Costs <2011>

The academy committee, all volunteers, albeit knowledgeable, managed to stay clear of politicizing, an accomplishment I’m not sure I could equal.

“A critical element of the Patient Protection and Affordable Care Act (ACA) is the set of health benefits—termed “essential health benefits” (EHB)—that must be offered to individuals and small groups in state-based purchasing exchanges and the existing market. If the package of benefits is too narrow, health insurance might be meaningless; if it is too broad, insurance might become too expensive. The Institute of Medicine (IOM) Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans concluded that the major task of the Secretary of Health and Human Services (HHS) in defining the EHB will be balancing the comprehensiveness of benefits with their cost.

“Not surprisingly, the work of this committee drew intense public interest. Opportunity for public input was offered through testimony at two open hearings and through the web. The presentations at the hearings reinforced for the committee the difficulty of the task of balancing comprehensiveness and affordability. On the one hand, groups representing providers and consumers urged the broadest possible coverage of services. On the other, groups representing both small and large businesses argued for affordability and flexibility. The committee thus viewed its principal task as helping the Secretary navigate these competing goals and preferences in a fair and implementable way.

“The ACA sets forth only broad guidance in defining essential health benefits, and that guidance is ambiguous—some would say contradictory.

First, EHB “shall include at least” ten named categories of health services per Section 1302 Second, the scope of the EHB shall be “equal to the scope of benefits provided under a typical employer plan.”
Third, there are a set of “required elements for consideration” in establishing the EHB, such as balance and nondiscrimination.
Fourth, there are several specific requirements regarding cost sharing, preventive services, proscriptions on limitations on coverage, and the like.

Taken together, these provisions complicate the task of designing an EHB package that will be affordable for its principal intended purchasers—individuals and small businesses.

“The committee’s solution is this: build on what currently exists, learn over time, and make it better. That is, the initial EHB package should be a modification of what small employers are currently offering. All stakeholders should then learn enough over time—during implementation and through experimentation and research—to improve the package. The EHB package should be continuously improved and increasingly specific, with the goal that it is based on evidence of what improves health and that it promotes the appropriate use of limited resources. The committee’s recommended modifications to the current small employer benefit package are:

(1) To take into account the ten general categories of the ACA;
(2) to apply committee-developed criteria to guide aggregate and specific EHB content and on the methods to determine the EHB; and
(3) to develop an initial package within a premium target.

“Defining a premium target, which is a way to address the affordability issue, became a central tenet of the committee. Why the Secretary should take cost into account, both in defining the initial EHB package and in updating it, is straightforward: if cost is not taken into account, the EHB package becomes increasingly expensive, and individuals and small businesses will find it increasingly unaffordable. If this occurs, the principal reason for the ACA—enabling people to purchase health insurance, and covering more of the population—will not be met. At an even more fundamental level, health benefits are a resource and no resource is unlimited. Defining a premium target in conjunction with developing the EHB package simply acknowledges this fundamental reality. How to take cost into account became a major task.

“The committee’s solution in the determination of the initial EHB package is to tie the package to what small employers would have paid, on average, for their current packages of benefits in 2014, the first year the ACA will apply to insurance purchases in and out of the exchanges. This “premium target” should be updated annually, based on medical inflation. Since, however, this does little to stem health care cost increases, and since the committee did not believe the DHHS Secretary had the authority to mandate premium (or other cost) targets, the committee recommends a concerted and expeditious attempt by all stakeholders to address the problem of health care cost inflation.

“An additional task related to that part of the committee’s charge directing it to address “medical necessity.” Medical necessity is a means by which insurers and health plans determine whether it is appropriate to reimburse a specific patient for an eligible benefit. For example, the insurance contract may specify that diabetes care is a covered benefit; whether it is paid for depends on whether that care is medically necessary for the particular patient—whether, for example, the patient has diabetes.

‘The committee believes that medical necessity determinations are both appropriate and necessary and serve as a context within which the EHB package is developed by a health insurer into a specific benefit design and that benefit design is subsequently administered. The committee favored transparency both in the establishment of the rules used in making those determinations and in their application and appeals processes. Indeed, since the design and administration of health benefits rather than the scope of benefits themselves are what appear to differentiate small employer plans from each other and from large employer plans, monitoring benefit administration is an important step in the learning process and updating of the EHB.

“Further, the committee stated that a goal of the updated EHB package is that its content becomes more evidence-based. The committee wishes to emphasize the importance of research about the effectiveness of health services and to emphasize that the results of this research, including costs, should be taken into account in designing the EHB package. New and alternative treatments, in the view of the committee, should meet the standard of providing increased health gains at the same or lower cost.

“Since the committee saw balancing comprehensiveness and affordability as the Secretary’s major task, it also recognized that any such balancing affected, and was affected by, individual and societal values and preferences. Thus, the committee recommends that both in the determination of the initial EHB package and in its updates, structured public deliberative processes be established to identify the values and priorities of those citizens eligible to purchase insurance through the exchanges, as well as members of the general public. Such processes will enhance both public understanding of the tradeoffs inherent in establishing an EHB package and public acceptance of what emerges.

“The committee recommended that the Secretary develop a process that facilitates discovery and implementation of innovative practices over time. A key source for this information will come from what states are observing or enabling them in their own exchanges. Moreover, the committee recommends that for states that operate insurance exchanges, requests to adopt alternatives to the federal essential health benefits package be granted only if these are consistent with ACA requirements and the criteria specified in the report and they are not significantly more or less generous than the federal package. State packages also should be supported by meaningful public input. The committee hopes that its work will be useful in assisting the Secretary of HHS to determine and update the essential health benefits and that its deliberations will be informative to the public. As with most issues of importance, the committee’s work involved balancing tradeoffs among competing interests and ideas. We hope this work is a positive step toward effective implementation of a key provision of the ACA.”

Since, in America the Litigative, the recommendations and implementation practices recommended by the EHB will be challenged in court, I recommend you read, if you skipped it, the previous topic on ‘Scientific Legal Evidence”.

A Reference and a Note

Essential Health Benefits — Balancing Coverage & Costs, 2011

http://www.nap.edu/catalog.php?record_id=13234

The PDF download is free!  PREPUBLICATION COPY – document is subject to editorial changes only.

A Note ASIDE:

Recent articles and studies on Implicit Prejudice, holding belief based and deeply buried prejudices, which daily affect your decisions. See: https://implicit.harvard.edu/implicit/ and Scientific American: The Implicit Prejudice 06/09/2006 Article [http://www.sciam.com/print_version.cfm?articleID=0004B0F0-7813-146C-ADB783414B7F0000] The implications of these hidden workings of our brains add much to how we make de3cision and ‘judge’ truth individually or in court.

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

General References

The National Academies Press

Recent NAP Releases  [http://www.nap.edu/new.html]

NAP—Environment and Environmental Studies [http://www.nap.edu/topics.php?topic=285&t=p]

NAP—Energy and Energy Conservation | Policy, Reviews and Evaluations   [http://www.nap.edu/topics.php?topic=358]

Other recent NAS/NAE/NAP topics I skimmed and found interesting and at times quite troubling.

  • Chemistry in Primetime and Online — Communicating Chemistry in Informal Environments <2011>
  • Environmental Impacts Of Wind-Energy Projects <2011>
  • Informing the Future — Critical Issues in Health, Sixth Edition <2011>
  • Relieving Pain in America — A Blueprint for Transforming Prevention Care Education & Research <2011>
  • On Being a Scientist — A Guide to Responsible Conduct in Research, Third Edition <2009>

Wikipedia for Background MaterialsYes I trust Wikipedia, but only if I’ve checkout most of an articles references for bias and accuracy! My Wikipedia checks are no different that my checking websites for whom their publishers represent and what causes they favor.

U.S. Government Accountability Office [GAO]   [http://www.gao.gov/]
Recent Reports and Studies. The GAO is the non-partisan 90-year old investigative arm of congress. In a similar manner, to my learning from NRC/NAP reports, many of the technology reports published by the Government Accountability Office make facilitating, if troublesome reading. NAS committee’s to which I have provided expert knowledge specifically in the nuclear waste area are thorough, relatively unbiased and always accurate in using reference materials.

Congressional Research Service [CRS]

The CRS is known as “Congress’s think tank” is the public policy research arm of the United States Congress. As a legislative branch agency within the Library of Congress, CRS works exclusively and directly for Members of Congress, their Committees and staff on a confidential, nonpartisan basis. CRS reports are highly regarded as in-depth, accurate, objective, and timely, but as a matter of policy they are not made directly available to members of the public. There have been several attempts to pass legislation requiring all reports to be made available online, most recently in 2003, but none have passed. Instead, the public must request individual reports from their Senators and Representatives in Congress, purchase them from private vendors, or search for them in various web archives of previously released documents.

The CRS is joined by two other congressional support agencies. The Congressional Budget Office provides Congress with budget-related information, reports on fiscal, budgetary, and programmatic issues, and analyses of budget policy options, costs, and effects. The Government Accountability Office assists Congress in reviewing and monitoring the activities of government by conducting independent audits, investigations, and evaluations of federal programs. [Partial Wikipedia Quote]

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

End Notes:

Copyright Notice — Product and company names and logos in this review may be registered trademarks of their respective companies.

Disclosure — Some of the articles quoted and listed in this column are copyright protected – their use is both acknowledge and is limited to educationally related purposes, which this column provides. They are likely covered by the Creative Commons Attribution-ShareAlike License.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s