Category Archives: Science

The Nursing Home Industry-Brown University Collaboration:  Science or a Sign of Growing Corporate Abuse of Power?

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    Dave Kingsley

The Growing Importance of Data

      The time has come for citizens to recognize the corrupting influence of university-industrial relationships and to organize efforts to call them out.  In a democracy, data generated in taxpayer funded healthcare systems should be controlled by the public through a democratic process. If corporate wealth and power are determining factors in who has access to healthcare data and/or who is recognized as legitimate analysts and interpreters of government information, the American people will be sitting ducks for manipulation, and exploitation.

    Growing problems resulting from big data and A.I. call for pushback by concerned scientists and citizens in general. Computing power and speed, massive collections of data, and technologically sophisticated data analytics will increasingly play a major role in the fairness, quality, and control of the U.S. healthcare system.  Control over these processes by industrial interests through manipulation of government agencies, universities, and political actors will result in inefficient, costly, corrupt, and inequitable healthcare.

An Example of Industry-University Collaboration in Real Time

     An insidious collaboration between the American Health Care Association (AHCA) and the Brown University Center for Gerontology & Healthcare Research (BU CGHR) serves as an example of how a university and industry can team up to thwart efforts by advocates to improve the quality of nursing home care.

 I have written about the Brown University-AHCA relationship in a previous blog post (here). However, a colleague recently sent me an article jointly authored by AHCA representatives and employees of BU CGHR which greatly increased my concern over the blatantly self-serving and corrupted nature of industry influenced research.

    The article[1], published in the Journal of the American Geriatrics Society, included six authors, four of whom are employees of the AHCA.  Ostensibly, the purpose of the article was to address the need for and cost of legislation requiring an increase in minimum staffing.  The authors concluded (based on their statistical analyses which I consider questionable at best) that the legislation would cost an additional $7.25 billion.  On page 7, they advance the usual deceptive AHCA hardship narrative that “SNFs operate under tight operating margins (median 0.7% in 2019), and margins have declined since 2013.”  They conveniently ignore cash flowing to investors through home office allocations and networks of related parties such as real estate, labor contracting, and a host of other subsidiaries.

    Even the lead author of the article is an AHCA employee.  Nevertheless, the article conflict of interest statement noted that “The authors report no financial conflicts of interest.” Saying that there is no conflict of interest in this publication is about as Orwellian as saying “War is Peace” (see: Brown University policy on conflicts of interest in university affiliated research (here).

    The conflict-of-interest statement included in the article describes the AHCA, as “the largest national trade association representing skilled nursing ….facilities.”  This is a clever filtering of reality through the most positive lens possible.  In fact, the AHCA represents not “facilities,” but chains of facilities owned by investment banks, private equity firms, real estate investment trusts, publicly listed C corporations, and other legal/financial corporate types..  Most of these corporations have multi-billion or multi-million-dollar revenues.  Furthermore, the AHCA has a large political PAC for influencing legislation on behalf of corporations funding them.

Science, Statistics, & Research Integrity

    When an industry can leverage the cachet of a venerable academic institution and produce dubious statistical models and write articles favorable to entities with a financial interest in the outcome of research, human rights and adequate healthcare will inevitably become secondary to cash flow.  Money takes precedence over healthcare, suffering is increased, and lives are shortened.

    Advocates and scholars must speak out about the Brown University collaboration with AHCE and other such industry-university relationships.  The role of government, think tanks, and philanthropic foundations in these relationships should not be overlooked either.  We cannot be passive. The problem of data control and manipulation by industrial interests will only deepen and become more serious and destructive as A.I. becomes available.  

    Let’s have a much-needed discussion about science and research integrity.  Let’s separate science from scientism.  Observational studies of complex, dynamic, social systems based on data dumps are beset with fallacies and they are easily manipulated.  Therefore, poor research with the imprimatur of a leading university unjustifiably undermines efforts to improve the quality of nursing home care.  When the nursing home industry chooses to withhold corporate financial information from the public, we cannot accept studies regarding staffing as scientific.  By providing only partial information, the industry and its lackies in Universities cannot claim to be basing their claims on scientific evidence.

[1] Hawk T., White EM, Bishnoi C. Schwartz LB, Baier RR, Gifford DR. Facility characteristics and costs associated with meeting  proposed minimum staffing levels in skilled nursing facilities. J. Am Geriatr Soc. 2022; 1-10. Doi: 10.1111/jgs. 17678.

The Disappearance of Scientific, Rational, Commonsense Thinking

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Dave Kingsley

In the Age of Show Business, Public Discourse Is Often Dangerous Nonsense

The current spread of absurd QAnon, conspiracist, white supremacist beliefs is the apotheosis of the takeover of our minds by infotainment, sound bite journalism, and the dumbing down of Western, liberal societies. Preceding the Trump presidency, a broad swath of the public was conditioned to believe about anything posted on the internet. So, a dangerous demagogue was able to capture the U.S. government by spreading hateful myths about an African American president and Hispanic immigrants.

A violent racist, anti-Semitic movement has also been intertwined with the growth of fanatical, anti-science religious groups across the U.S. In the early 2000s the “religious-right” successfully attacked and derogated science curricula in public schools. Critical thinking in science classes was significantly diminished.

There is no doubt in my mind that the failure of progressives, liberals, moderates, and principled conservatives to counter a crazy right-wing attack on science has contributed to the growth of irrational beliefs – leading to hundreds of thousands of preventable deaths during the raging COVID. It was hard for us to believe that a Donald Trump and what he has wrought would really happen in this country. We thought that the moral high ground would be good enough and our emotional appeals to human decency would be a viable narrative and strategy.

Beware of Slick, Simplistic Presentations

Science is skeptical. It is also hard work. In the age of show business, the most entertaining and amusing presentations will grab attention of an audience far quicker than substance requiring some mental effort. Nevertheless, empirical evidence in support of a position is absolutely necessary.

Science is a process. Hence, it is also necessary for the audience to not only respect the credentials of presenters – if they actually have the credentials – but at the same time, the audience and colleagues must be engaged in an exchange. Do we understand each other? How do we deepen our knowledge and make better decisions in the public interest? What can we all contribute to the effort? These are questions designed to prevent audiences given to passive acceptance to whatever expert or even charlatan is disseminating.

Advocates & Activists Must Demand Scientific Analyses and the Truth: We Owe it to our Fellow Humans

Professionals and volunteers advocating and agitating for better conditions for those around us deprived of human decency and subjected to dehumanizing and abusive medical care are responsible for seeking the truth. For example, the financial-real estate-medical industrial complex is providing misleading information about the federal and state funds flowing into and out of the nursing home system.

The long-term care industry has been able to trick legislators, advocates, and the public far too long with their hardship pleas. The truth is this: the nursing home system is structured for the flow of capital through an opaque pipeline, which in the final analysis benefits ultra high net worth individuals and contributes to the maldistribution of wealth.

Commonsense, scientific, rational thinking is needed to debunk the false narratives of an industry dedicated to finance rather than humane care. That is what this blog is all about and we will advocate and agitate for a counter to the nonsense far too often swallowed by legislators, regulators, the media, and the public. We can see what’s coming. Things will not get better on their own.

The Threat of White Nationalist Terrorism to American Democracy: A Common Sense Understanding

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Max Skidmore

Editor’s Note: This post by Max Skidmore is an excerpt from his recently published book The Common Sense Manifesto (Washington, D.C.: Westphalia Press, 2020, 41-43). It is important to remember that this was published in February 2020, nearly a year before the violent insurgency that attempted to seize power from the United States Congress. Then, consider how much recent events have demonstrated that this warning was not exaggerated; the United States was threatened by a clear and present danger from right-wing extremists, and also from self-described “conservatives,” who constituted the Republican Party.

Law enforcement officials became aware decades ago that one of the greatest dangers threatening Americans came from white nationalists, and from various neo-Nazi groups. This is especially true given the widespread availability of even the most lethal firearms to virtually anyone in the United States. Prudently, the Department of Homeland Security began to look carefully at such groups, and to study them seriously. 

When they learned of such studies, though, American conservatives raised vehement protests. Studies of threats from the extreme right, they shrieked, were attempts to suppress “conservatives.”  So powerful was their reaction that the Department of Homeland Security halted all such studies. Republican office holders recognized immediately that studies of right-wing dangers absolutely required study of the dangers of American conservatism, itself. 

Damning examples are easy to find.  In 2016, Ron Nixon wrote in the New York Times that “Homeland Security Looked Past Antigovernment Movement.”[1] In 2012, an article in Wired was titled, “DHS Crushed This Analyst For Warning About Far-Right Terror.”[2] As far back as 2011 the Washington Post reported that “Homeland Security Department Curtails Home-Grown Terror Analysis.”[3] All that led to the anguished cry in November of 2018 that “Law Enforcement Failed to See the threat of White Nationalism. Now They Don’t Know How to Stop it.”[4]

The irony of the situation is what it says about the unintended candor of the conservatives who protested in the first place. In a twisted way, there is something humorous here. Despite their generally staid lifestyles as privileged members of the moneyed elite, Republican elected officials argued that targeting dangerous extremists—those who were often living in the woods while stockpiling assault weapons and the like—was to target “conservatives.” 

They were closer to being accurate than they seemed. The casual observer could have thought of this as paranoid nonsense, but the conservatives knew better. They knew very well that the most violent elements of society were kindred souls ideologically with themselves. As the discussion here makes clear, the violent potential of their ideology brought them closer to their alt-right relatives. Such closeness between overt violent extremists and their kindred in the alt-right has brought about a most terrifying result. 

The Republicans have energized the most violent, and least rational, segment of the American electorate.  Because of the electoral college that disregarded nearly three million more votes for Hillary Clinton, they managed to elect to the presidency of the United States an ignorant and malevolent buffoon. Despite some early criticisms from a few Republicans, he quickly became “their guy,” and Republicans lined up to give him their firm support as he slashes, burns, and rips. 

At the same time, he also whines, and complains that he is being mistreated. He, who obviously knows almost nothing about history or past presidents, says that he is being treated more unfairly than any other president in history.

A widespread uprising has yet to be experienced, but irrational violence is becoming increasingly common. Mass murders are so frequent that they seem almost to have become normalized. On 3 August—on a single day—there in fact were two such massacres by white nationalist terrorists, widely separated. The first was in El Paso, Texas, followed shortly by the other in Dayton, Ohio. Each caused multiple deaths. Even Trump conceded that “perhaps” more should be done (at least until later, when he backtracked after having spoken with an NRA official). His supporters, and perhaps others as well, say that it is unfair to hold Trump responsible. To anyone familiar with American politics, and with Trump’s rhetoric, common sense should make it impossible to deny a definite connection.

[1] Ron Nixon, “Homeland Security Looked Past Antigovernmental Movement, Ex-Analyst Says,” New York Times (8 January 2016), https://www.aol.com/article/news/2019/03/17/white-house-dismisses-praise-of-trump-by-new-zealand-shooter/23694289/ (accessed 27 March 2019).

[2] Spencer Ackerman, “DHS Crushed This Analyst  For Warning About Far-Right Terror,” Wired, (7 August 2012), https://www.wired.com/2012/08/dhs/ (Accessed 27 March 2019).

[3] R. Jeffrey Smith, “Homeland Security Department Curtails Home-Grown Terror Analysis,” The Washington Post(7 June 2011), https://www.washingtonpost.com/politics/homeland-security-department-curtails-home-grown-terror-analysis/2011/06/02/AGQEaDLH_story.html?noredirect=on&utm_term=.abfcf3e66cc2 (accessed 27 March 2019).

[4] Janet Reitman “U.S. Law Enforcement Failed to See the Threat of White Nationalism. Now They Don’t Know How to Stop it,” The New York Times Magazine (3 November 2018), https://www.nytimes.com/2018/11/03/magazine/FBI-charlottesville-white-nationalism-far-right.html (accessed 27 March 2019).