Sunday, May 27, 2012
Policing our own
The gist of the story is that agents in Columbia, who were acting as an advance team for President Obama, were caught with prostitutes in their hotel rooms. This was not the product of a specific sting effort but actually was the consequence of one particular agent trying to stiff (no pun intended) a prostitute who had spent the night with him. She was not awed by the vaunted Secret Service and went through her usual channels to expose a customer who failed to live up to their end of the bargain. Thus, this particular episode ended up with a Congressional hearing. Who would have figured.
I read Maureen Dowd's piece in the New York Times this morning and perhaps the most intriguing port were the comments. What I took away from the comments was that the specific behaviors which the agents engaged in are view is many different lights by the public at large. I suspect that there is also a similar spectrum of belief held by their fellow agents. From the perspective of the Secret Service, there is no question that hiring prostitutes, while technically not illegal in Columbia, places the agency and their charges at some additional risk and is therefore unwise. However, the magnitude of the risk is undefined and from the perspective of the agents involved, it may appear to be very small since it is highly likely that they have been watching behaviors like this for years and nothing has happened. They likely view this in the same light we view coming to a rolling stop at a stop sign or having a few glasses of wine with dinner and driving home. Probably not the smartest thing to do but everyone does it.
While the Secret Service story holds the public because of the obvious titillation factor; sex, powerful men and wasteful and inept government, there is a broader message here. Congress is now up in arms because the Secret Service appears to be incapable of policing itself. This is not surprising but what should also not be surprising is that the inability to self police is not unique to the Secret Service. Look elsewhere and what you will see is the same phenomena, in financial markets, in education, in biomedical research, in health care, the Catholic Church, and the Penn State athletic programs to name but a few in the news recently.
What all of these have in common is that these entities are made of communities of people who have a wide range of views as to acceptable and not acceptable behaviors. Furthermore, most people are inclined to leave other people alone and not challenging their peers, short of the most egregious activities. I can attest to situations within health care and biomedical research where I have observed varying degrees of compulsiveness in adhering to particular norms.
In the health care practice realm, we are constantly faced with scenarios where we are in a position to second guess someone else's judgment, almost always without a complete story. When does a particular behavior reach the threshold for a response? Was that informed consent really adequate? Was that really the indicated procedure? Did that patient warrant treatment with that drug and were they really aware of the risks involved? The default mode is to take care of what you can take care of and ignore the rest. Periodically we face situations where particularly egregious examples of behavior hit the press where physicians have been committing outlandish acts and it appears that no one appears to care or they may even be viewed in very positive lights until the OIG or other oversight body brings the hammer down.
In the case of biomedical research, the recent observations that much published high impact basic and clinical trials cannot be repeated would imply that a similar dynamic exists in this realm. We have peer review but the recent revelations point to limits of the peer review system in dealing with issues like these. Within our own research programs we grapple with the tension between publishing good vs. perfect data. Waiting for perfect results means that you will never publish anything. However, within the scientific community there exists a range of standards for what constitutes good enough and a potential for a funding advantage to redefine that good enough standard to a more minimal threshold. Does something constitute sloppiness if actual dishonesty? Where does that stop and how do we police this?
However, before we call for creating of in increasingly complex regulatory environment, we need to recall that this does not appear to work so well either. Those regulated and those who do the regulation often become partners in what has been termed regulatory capture. Human nature being what it is means that we are not to be trusted and not amount of third party oversight can domesticate the risks of dealing with people. The world works on trust but the truth is no one or things made up of people can be completely trusted. Good institutions are compatible with bad outcomes and our quest to perfect them and perfect people may result in unintended and less desirable results.