A moral problem?

What works?  In particular, which social programs work?  One way to find out might be to copy some of the procedures for clinical trials for drugs.  For example, your city might be considering funding a program for homeless that  places them in apartments and gives them rent and subsidies for 6 months while they get job training.  One thing to do would be to sign up two groups to track, those that get the help and those that do not.

There are similar trials going on in the US and in developing countries.  For example, one might wonder whether having a reliable source for vaccinations with small non-monetary rewards would help with the low rate of compliance in a country.  One thing might be to divide villages into those that get the resource (and/or the rewards)  and those that do not, and then track the vaccination of children.  Here is a web site with descriptions of some of the trials in developing countries.  The lead investigator on that site, Ester Duflo of MIT,  was profiled recently  in the New Yorker; the full article is ‘gated’ for subscribers only, but the lengthy abstract will given you an idea if you want to pursue it through libraries.

In fact, in NY City such a trial is going on to test a program called Homebase,which was  begun in 2004, and offers job training, counseling services and emergency money to help people stay in their homes.  Now when you apply to Homebase you have to agree to be part of a lottery that will determine whether or not you are part of the program.

The testing of Homebase has become very controversial.   Those against it maintain that one should not treat people, particularly very disadvantaged people, like “lab rats.”  The pro advocates say that money is limited and good data is needed to make the decisions about which programs to implement.

Who is right?  What do you think?

Let me make two observations: 

1.   The trial in NY City is unlike the drug trial in one significant respect:  you know from the beginning whether or not you are getting the real thing.  Further, those who aren’t know that others are, and that it is just random bad luck that is preventing them from getting it.  In fact, both groups have to accommodate the fact that random luck has made the difference in their getting the chance.  Duflo mentions a comparable problem with a project in India; once people know they are being tested, the motivations for behavior can increase.

2.  Proponents of the program in NYC argue that not everyone could get the resources anyway and they are just tracking those who don’t.  But this may not be true, since the grounds for deciding who does and who does not get into the program appear to be different.  It didn’t used to be done by lottery.  In fact, the story of one women going through the lottery and losing is heart-breaking.   Does that signify a moral difference that may not be present in all the cases?

Well, I don’t have all the answers.  What do you think?

6 thoughts on “A moral problem?

  1. I’m not really an expert, though my job does involve statistical modeling– I wonder if maybe randomized controls trials are overrated. Perhaps we can just have the programs we would have (with the limited funding, and hard choices we’ve always had), and identify ‘confounding’ factors well enough.

    Given your observations about motivation, maybe modeling based on non-randomized studies (really just data from whatever-we-would-have-done-anyway) would actually work *better*.

    I dunno about the moral issues, though.

  2. I studied this, in my medical anthro course. Mark my words, it’s not about straightforward operant conditioning principles in the case of vaccinations in India. People in parts of India (my apologies, I’m not well versed enough to point out which parts and why) have very complicated taboos against certain types of medicine. They are sometimes very mistrustful of western doctors as well.

    If it was only about the payment, dontcha think the numbers would have spiked well above 32% ?

    My guess would be that the beans lured the people who were so impoverished that they were willing to let their taboos slide for a little food. I’m not so sure about a practise like this, even if it does save children’s lives. It doesn’t sit well with my intuitions. Taboos are powerful things. Consider how desperate you’d have to be to accept payment for eating worms. Even if they were testing the effects of worms as a possible cure on cancer patients, and you were one, what would it take to convince you that they weren’t trying to punk you?

    How would you feel if you found out the experiment was only to prove or disprove the hypothesis “People will even eat worms if the price is right”?

    No, these people need an informant, a go-between to break down the belief system and get to the real beliefs that undermine these wellness strategies. The solution may be something as simple as allowing oral rather than intravenous vaccinations, or “cooling” the little ones’ bellies with some goat’s milk during oral vaccines. I’m sure these women would appreciate honest communication much more than walking away feeling like they may have injured their children for a handful of beans that they were too hungry to refuse. Magic beanstalk and golden harp or not.

  3. I couldn’t find the Homebase program. Your link put me into the study in India again. I’d like to check that one out, tho. My intuitions are a little different when I’m thinking about something closer to home.

  4. Well, David, there’s honest as in would you like us to help you, and what do you think is best for your baby, with a solid understanding of proxemics and gestures that a group of people consider rude, and which ones are ok.

    Then there’s the ethnocentric missionary’s brand of honest communication, which states, we’re going to help you and this is how. Here’s your money, and no consideration as to whether or not my very manner of looking you in the eye may be offensive to you.

    Do you see a difference?

  5. Xena, thanks for letting me know about the link; it should be ok now.

    There was no indication in the paper on India that she was dealing with a taboo. That would have been very relevant and I think she would have mentioned it if it were true.

    I’m not sure what’s behind the remark about whether it was only about payment. To go from something about 6-9% to 32% seems extraordinary.

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