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Antimicrobial stewardship programs typically use days of therapy to assess antimicrobial use. However, this metric does not account for the antimicrobial spectrum of activity. We applied an antibiotic spectrum index to a population of very-low-birth-weight infants to assess its utility to evaluate the impact of antimicrobial stewardship interventions.
We compared the use of recto-anal mucosal swab (RAMS) culture and faecal culture for the detection of E. coli O157 in a mob of Merino sheep. Fifty Merino wethers and maiden ewes housed in indoor pens were sampled on five occasions. We detected E coli O157 in 32% (16/50) of sheep, with weekly prevalence ranging from 4% (2/50) to 16% (8/50). Overall, 12·5% (2/16) were detected by RAMS culture only, and 37·5% (6/16) were detected by faecal culture only. The level of agreement between the two sampling methods was moderate [kappa statistic = 0·583, 95% confidence interval (CI) 0·460–0·707]. The relative sensitivities of RAMS and faecal culture were 67% (95% CI 41–86) and 57% (95% CI 34–77), respectively. We identified four super-shedding sheep using direct faecal culture. Although the majority of culture-positive sheep were detected at one sampling point only, 3/4 super-shedding sheep were culture-positive at two sampling points, and 1/4 was culture-positive at four sampling points. Persistent culture positivity may indicate sheep that could be considered ‘super-shedders' at some point. The use of immunomagnetic separation further improved the rate of detection of E. coli O157, which was isolated from 1/34 animals that were previously negative by enrichment culture alone. A significant difference between sampling weeks was detected for both faecal (P = 0·021) and RAMS (P = 0·006), with the prevalence at the mid-point of sampling (week 4) significantly (P < 0·05) higher than at the beginning or end of the study. Study conditions (penned sheep) might have been responsible for the high prevalence and the epidemic pattern of infection observed, and could serve as a future model for studies of E. coli O157 transmission, shedding and super-shedding in sheep.
Single and multi-mode room temperature laser action was observed in GaN pyramids under strong optical pumping. The 5- and 15-micron-wide hexagonal-based pyramids were laterally overgrown on a patterned GaN/AlN seeding layer grown on a (111) silicon substrate by metal-organic chemical vapor deposition. The pyramids were individually pumped, imaged, and spectrally analyzed through a high magnification optical system using a high density pulsed excitation source. We suggest that the cavity formed in a pyramid is of a ring type, formed by total internal reflections of light off the pyramids’ surfaces. The mode spacing of the laser emission was found to be correlated to the size of pyramids. The effects of pyramid geometry and pulse excitation on the nature of laser oscillations inside of the pyramids is discussed. Practical applications of the results for the development of light-emitting pixels and laser arrays are suggested.
Single and multi-mode room temperature laser action was observed in GaN pyramids under strong optical pumping. The 5- and 15-micron-wide hexagonal-based pyramids were laterally overgrown on a patterned GaN/AlN seeding layer grown on a (111) silicon substrate by metal-organic chemical vapor deposition. The pyramids were individually pumped, imaged, and spectrally analyzed through a high magnification optical system using a high density pulsed excitation source. We suggest that the cavity formed in a pyramid is of a ring type, formed by total internal reflections of light off the pyramids' surfaces. The mode spacing of the laser emission was found to be correlated to the size of pyramids. The effects of pyramid geometry and pulse excitation on the nature of laser oscillations inside of the pyramids is discussed.
We present a comprehensive study of the optical characteristics of AlxGa1−xN epilayers by means of photoluminescence (PL), PL excitation, and time-resolved PL spectroscopy. All AlxGa1−xN epilayers were grown by metalorganic chemical vapor deposition and the Al mole fraction (x) was varied from 0 to 0.6. We observed that (i) the full width at half maximum of the PL emission, (ii) the energy difference between the PL emission peak energy and the PLE absorption edge, and (iii) the effective lifetime increase with increasing x. These facts indicate that degree of band-gap fluctuation due to a spatially inhomogeneous Al alloy content distribution increases with increasing x. We observed anomalous temperature-induced emission shift behavior for AlxGa1−xN epilayers, specifically, an S-shaped (decrease-increase-decrease) temperature dependence of the peak energy with increasing temperature. This anomalous temperature-dependent emission behavior was enhanced as the Al mole fraction was increased. Since the band-gap fluctuation in AlxGa1−xN epilayers due to inhomogeneous spatial variations of the Al content increases with increasing Al content, we believe that band-gap fluctuation causes the PL peak energy to deviate from the typical temperature dependence of the energy gap shrinkage. Therefore, the anomalous temperature-induced emission shift can be attributed to energy tail states due to alloy potential inhomogeneities in the AlxGa1−xN epilayers with large Al content.
The tenuous claims of cost-benefit analysis to guide policy so as to promote welfare turn on measuring welfare by preference satisfaction and taking willingness-to-pay to indicate preferences. Yet it is obvious that people's preferences are not always self-interested and that false beliefs may lead people to prefer what is worse for them even when people are self-interested. So welfare is not preference satisfaction, and hence it appears that cost-benefit analysis and welfare economics in general rely on a mistaken theory of well-being. This essay explores the difficulties, criticizes standard defences of welfare economics, and then offers a new partial defence that maintains that welfare economics is independent of any philosophical theory of well-being. Welfare economics requires nothing more than an evidential connection between preference and welfare: in circumstances in which people are concerned with their own interests and reasonably good judges of what will serve their interests, their preferences will be reliable indicators of what is good for them.
Michael S. McPherson (1947–) received his Ph.D. from the University of Chicago and taught for many years at Williams College before becoming President of Macalester College and then of the Spencer Foundation. His academic work concerns the economics of higher education and issues at the boundaries of economics and ethics. He and Daniel Hausman founded the journal Economics and Philosophy in 1985 and edited it for its first ten years. They also coauthored Economic Analysis, Moral Philosophy, and Public Policy, from which this essay derives.
Let us begin with an old joke. Brezhnev and other members of the Soviet Central Committee are reviewing a May Day parade in Moscow. Thousands of infantry march by, followed by armored cars, the latest tanks, long range artillery, and progressively larger, sleeker, and more impressive missiles. At the end, a battered flatbed truck rumbles by carrying a half-dozen unathletic and bespectacled middle-aged men and women in dirty raincoats sitting around a card table. The crowd is restless and members of the Central Committee are scandalized. One is bold enough to ask Brezhnev what these nondescript civilians are doing in the midst such a magnificent military parade. Brezhnev replies, “Ah, those are our economists. You'd be amazed at the damage they can do.”
Like most economist jokes, this one is unkind, but its unkindness should not be exaggerated. It refers to the damage economists can do, not to any inevitable harm that they cause. And there is no suggestion that their intentions are evil.
This book will be filled with arguments, but examples help bring them down to earth. One good example may do more to clarify how ethics matters to economics than would a hundred pages of argument. Furthermore, ethics is not just logic. Emotion has its part to play, too, and examples help to engage the emotions. In this chapter and the next, our concern is not to argue that ethics matters in economics but instead to exhibit – through examples – how important ethics is.
In this chapter we will focus on two examples, which will enable us to identify all the main moral assumptions that characterize mainstream normative economics. The first example caused an uproar.
A Shocking Memorandum
In December of 1991, Lawrence Summers (now president of Harvard University, but then the World Bank's chief economist) sent the following memorandum to some colleagues.
Just between you and me, shouldn't the World Bank be encouraging more migration of the dirty industries to the LDCs [less developed countries]? I can think of three reasons:
(1) The measurement of the costs of health-impairing pollution depends on the foregone earnings from increased morbidity and mortality. From this point of view a given amount of health-impairing pollution should be done in the country with the lowest cost, which will be the country with the lowest wages. I think the economic logic behind dumping a load of toxic waste in the lowest-wage country is impeccable and we should face up to that.
As we saw in Chapter 9, contemporary “Paretian” welfare economics is of relatively little help in evaluating economic institutions and outcomes. Welfare economists often espouse the Pareto principle (that A is better than B if somebody prefers A to B and nobody prefers B to A), but it's a rare day when there is this sort of unanimity. Welfare economists are sometimes tempted to say that A is better than B when A is only a potential Pareto improvement, but as argued in Chapter 9, this view is dubious. Economists need better bases for evaluating economic outcomes and institutions.
The Social Welfare Function and Arrow's Theorem
Social choice theory evolved out of an effort to construct better tools for evaluation. Following Bergson (1938) and Samuelson (1947), let us call any ranking of social states a “social welfare function.” Normative principles can be regarded as constraints on social welfare functions. For example, resource egalitarianism demands that social welfare functions favor egalitarian resource distributions. Nazi principles of “racial purity” narrow the set of acceptable social welfare functions to those that give a low ranking to states of affairs in which Jews prosper. Hedonistic utilitarianism picks out social welfare functions that rank states of affairs in terms of total happiness.
The point of discussing social welfare functions is to provide a framework for exploring normative principles. Although the framework could in principle be applied to a broad range of evaluative criteria – including highly nonindividualistic ones – social choice theorists have in practice focused on social welfare functions whose arguments are individual preferences.
The contemporary world is full of inequalities that most people find profoundly disturbing. For example, the median wealth of American families of African ancestry is about one tenth that of families of European ancestry. In 2000, life expectancy at birth in Japan was about 81, compared to 38 in Angola. In 1970, the top hundred American executives earned on average 38 times what the average full-time worker earned; in 2000, the ratio was more than 1,000 to 1 (Detroit News, 19 December 2002). One percent of Americans own at least a third of all America's wealth, while the bottom 40% of the population has only 1%. In 1998, the assets of the world's 358 billionaires were greater than the combined incomes of countries with 45% of the world's population – more than 2.5 billion people (〈http://www.globalpolicy.org/socecon/inequal/〉). Inequalities in wealth also correlate with other inequalities. Unsurprisingly, those who are richer tend to have higher incomes. Those with higher incomes also tend to be healthier, better educated, of higher status, taller, and to have more political influence.
What's wrong with inequalities? Why do most people find these inequalities so troubling? Notice first that it is not just the size of the inequalities that makes them disturbing. The disparity of life expectancy between infants born with Tay-Sachs disease (who usually die before age 5) and those without the disease dwarfs the inequalities in life expectancy between Japan and Angola, but it does not raise the same moral problems. Why?
Economics portrays agents as choosing rationally. Many generalizations in economics concerning how people do in fact choose are also claims about how agents ought rationally to choose. This fact distinguishes economics from the natural sciences, whose quarks and polymers do not choose at all and whose theories have no comparable normative dimension.
The theory of rational choice that dominates economics derives from an everyday theory of human choice, which has been called “folk psychology.” This theory takes actions to derive jointly from beliefs and from a wide array of motivational factors such as urges, emotions, habits, and commitments. So, for example, when one rainy Friday night a hungry student named Ellen takes a frozen pizza out of the refrigerator, unwraps it, puts it in a stove, and turns knobs on the stove, we folk psychologists explain Ellen's action by Ellen's beliefs – including especially her beliefs that turning the knobs will cause the stove to heat the pizza – and by her desire to eat hot pizza.
This sort of explanation is familiar but not very satisfactory. Ellen might also like to eat her pizza frozen, or she might also have a desire to reheat some leftover meatloaf. Or she might rather skip dinner and keep studying decision theory. What explains her action is not merely wanting to eat hot pizza (plus possessing the requisite beliefs) but also wanting to do this as much or more than she wants to do any of the feasible alternatives.
Though well-being is obviously important, people also care deeply about freedom, rights, equality, and justice – indeed, people risk their lives pursuing them. Economists would be wrong to assume that welfare is all that matters. Even if economists themselves had no interest in anything except welfare, they would still need to understand these other values in order to understand the goals of policy makers and to help devise policies that achieve these goals.
But it is patently not the case that economists are indifferent to these other moral concerns. On the contrary, economists care as deeply about freedom and justice as do other people. These other values may be difficult to understand, but welfare is not a simple notion either. In assessing economic outcomes, processes, institutions, and policies, economists need to be sensitive to the whole range of moral concerns.
In Part III we shall discuss many important moral notions under the headings of liberty and rights (in Chapter 10), equality (Chapter 11), and justice (Chapter 12). Our way of classifying the issues is an expository convenience, and readers should not take it too seriously. Nor should readers take our discussion of these important moral notions as exhaustive. For example, the deepest moral commitments of many of those concerned to protect wilderness areas are not captured in these chapters. What is important to keep in mind is that there are many important moral notions that are distinct from the notion of well-being.
The questions of justice that are important to economists concern the distribution of benefits and burdens among members of a community. What claims can persons legitimately make upon one another or upon the state? What burdens can the state place on its citizens, or can individuals place on one another? Because justice is concerned with the proper distribution of scarce resources in society, its subject matter overlaps with economics.
Economists cannot decide what principles of justice to rely on merely by consulting public opinion, because people are committed to many principles of justice, which are at differing levels of generality and are often ambiguous and conflicting. Even when there is a social consensus on a principle of justice, it may not be well considered, and economists may still not find much guidance. Consider, for example, equality of opportunity. Everybody is for it, but that's partly because there's so little agreement about what it is. Does equality of opportunity require that more resources be devoted to the education of the relatively disadvantaged? Does equality of opportunity require steeper inheritance taxes? Does equality of opportunity rule out affirmative action or require it? Questions about the extent to which economic policies contribute to equality of opportunity can scarcely be broached until the concept itself is clarified. Economic evaluation presupposes well-defined principles of justice.
Both Lawrence Summers's argument that the World Bank should facilitate the transfer of polluting industries to poor countries and the efficiency argument for school vouchers are instances of standard welfare economics. If parents are permitted to choose among competing schools then their preferences will be satisfied at least as well as in a state-sponsored system, and competition among schools will induce cost savings and improvements in quality. Concerns about the distributional consequences can be addressed by a system of vouchers, which can be as generous or stingy toward those who are poor as the citizenry wishes. Similarly, the massive inequalities in incomes, wages, and environmental quality between rich and poor countries and the fact that pollution damage is not a marketable good create opportunities for Pareto improving trades (or industry relocations) between rich and poor countries, which the World Bank can facilitate. Uncompensated transfers of pollution to LDCs (like the simple elimination of public support of education) cannot be justified in this way, since doing so would not be beneficial to all parties. Yet even uncompensated pollution transfers would apparently represent potential Pareto improvements and would be viewed favorably from the perspective of cost–benefit analysis.
We went on to suggest a number of objections to these arguments. In addition to distributive concerns, voucher plans must be responsive to the paternalistic and political reasons why governments support education. In Chapter 2 we suggested that, although these considerations do not necessarily defeat the argument in support of a voucher system, they do support constraints on its structure.
Game theory was conceived as a tool to explain, predict, and guide behavior in strategic interactions among individuals, and its main applications still lie in this domain. But game theory is less wedded to a particular set of questions than is social choice theory, and it has applications to such disparate phenomena as computer programming and biological evolution. Game theory might indeed be regarded as a branch of mathematics rather than as specifically a theory of interactive decision making. However, in this chapter we will focus exclusively on applications of game theory to strategic interactions among individuals. An interaction among individuals is “strategic” if the payoffs to some individuals depend on the choices of others.
What Is a Game?
A game is defined by its players, the strategies that are available to the players, the payoffs to the players from each combination of strategies, and the capacities of the players, including especially the knowledge each player has concerning the other features of the game. Each of the italicized terms has a technical meaning. In the case of the games we shall consider, players are simply people. To keep things simple, we shall for the most part discuss games with only two players. A specific strategy for a player is a complete specification of what actions the player will take whenever the player gets to act. The specification of the strategies available to a player defines all possible actions that the player can take.
We hope in this book to have shown how knowing moral philosophy can help one to do economics better. The most persuasive way to make this case is the one we pursued in the main text: by describing important aspects of moral philosophy and showing their bearing on economics. But many economists are inclined to deny that moral philosophy has anything to do with economics. Why? In this appendix, we shall explore the reasons and reaffirm the conclusion of this book – that ethics is relevant to economics.
As explained in Chapter 1, one can distinguish between “positive” and “normative” inquiries. Positive inquiries address factual questions, whereas normative inquiries address evaluative questions. Although it sounds paradoxical, it is possible to regard what is called “normative economics” as a positive inquiry into the logical presuppositions and practical means to satisfy preferences efficiently, and some economists have in fact viewed normative economics in this way. Most economists, however, concede that normative economics is a normative inquiry addressing evaluative questions and prescriptions; and, as our discussion in Chapters 2 and 15 shows, arguments such as the Summers memorandum do not address only factual questions.
Hence we shall interpret those economists who would deny that moral philosophy is relevant to economics as distinguishing positive and normative economics, as conceding that moral philosophy is relevant to normative economics, and as denying that moral philosophy is relevant to positive economics.
Economic outcomes may be better or worse along several dimensions. Some may make people better-off. Other outcomes may show more respect for human dignity, and still others may permit greater freedom. To decide which dimensions are more important requires moral judgment.
As illustrated by Larry Summers's memorandum (discussed in Chapter 2), economists evaluate outcomes in terms of individual welfare. One outcome is better than another if and only if the first makes people better off than the second. Since the evaluation of outcomes rests exclusively on their consequences for individual welfare, the theory of individual welfare is crucial to normative economics. Indeed, normative economics is often called “welfare economics.” As we saw in Chapter 5, economists take welfare to be the satisfaction of preferences.
Economists evaluate institutions and policies as well as outcomes. In principle, institutions and policies might be evaluated in many ways; for example, markets might be valued because of the freedoms they involve regardless of whether they promote individual well-being. But in fact economists assess institutions and policies in terms of their welfare consequences. So, for instance, economists typically value freedoms for their contribution to welfare. Economists focus on only one of the many evaluative questions they could ask about economic institutions, policies, and outcomes: “How well do they satisfy preferences?”
Part II focuses on welfarism – the evaluation of outcomes, institutions, actions, and policies in terms of their effect on individual welfare. Chapter 7 discusses utilitarianism, which ties assessment to total or average well-being.
We opened this volume with four examples of work in economics that reflects ethical views. If this book has served its purpose as an analysis of the ethical presuppositions of economics and as an introduction to a range of ethical concepts and theories, it should make the ethical commitments implicit in these cases easier to understand, and it should suggest how they might be influenced by a broader and more self-conscious ethical perspective. We have also – especially in the last two chapters – said a bit about tools that economists have developed that may be of use to moral philosophers, and we wish also to say something about ways in which economists and philosophers can together help to address some of the daunting problems facing the nations of the world.
Accordingly, in the concluding chapters we shall revisit the four cases discussed in Chapters 2 and 3 and offer some remarks about ways in which grasping both ethics and economics might help in identifying good policies and principles for citizens and governments to adopt. In Chapter 15 we shall return to the two examples of normative economics discussed in Chapter 2 – the defense of school vouchers and Larry Summers's proposal that the World Bank encourage polluting industries to locate in poor countries. In particular, Chapter 15 will show how the discussions in Parts II and III of welfare and of nonwelfarist evaluative considerations help one to understand and appraise these arguments.