The scandals of covid-19

Where clinicians once believed "there is no harm trying,” they realise that CPR offers little benefit to patients but brings significant risk to staff as they wait for the protective equipment that was promised in the UK and globally (doi:10.1136/bmj.m1423;doi:10.1136/bmj.m1367). Adding to the scandals of unpreparedness and lack of personal protective equipment is the scandal of testing. Germany's relatively low case fatality rate is helped by an "early and high level of testing” (doi:10.1136/bmj.m1395).

Seven days in medicine: 6-12 May 2020

In a report summarising the feedback it had received,2 the charity noted a litany of "horrendous” safety concerns, as workers were concerned about a lack of personal protective equipment and about their mental health. NICE: assess covid patients for kidney injury Patients with suspected or confirmed covid-19 should be assessed for acute kidney injury (AKI) on hospital admission or transfer, said the National Institute for Health and Care Excellence (NICE). In a new guideline aimed at healthcare professionals who are not kidney specialists, the institute said that patients with suspected or confirmed covid-19 should be monitored for AKI throughout their stay in hospital and managed appropriately if it develops.

The Early Warning Mechanism of Public Health Emergencies Through Whistleblowing: A Perspective Based on Considering the Uncertainty of Risk Perception.

Purpose: During the early warning period of public health emergencies, the information released by whistleblowers on the risk posed by the given event can reduce uncertainty in the public's risk perception and help governments take timely actions to contain the large-scale dissemination of risk. The purpose of this study is to give full play to whistleblowers and draw attention to the risk events, forming a pluralistic model of the risk governance during the early warning period of public health emergencies. Methods: We construct an evolutionary game model of the early warning of public health emergencies through whistleblowing that involves the government, whistleblowers, and the public, discussing the mechanism of interaction between these subjects under the uncertainty of risk perception. Furthermore, we use numerical simulations to analyze the influence of changes in the relevant parameters on the evolutionary trajectory of the subjects' behaviors. Results: The results of the research are obtained by numerical simulation of the evolutionary game model. The results show that the public's cooperation with the government encourages the latter to take a positive guidance strategy. Increasing the reward for whistleblowers within an acceptable cost, strengthening the propaganda of the mechanism and the higher level of risk perception of the government and whistleblowers will promote whistleblowers' vocalization actively. When the government's reward for whistleblowers is lower, the whistleblowers choose negative vocalization with the improvement of the public's risk perception. If there is no mandatory guidance from the government at this point, the public is prone to passively cooperating with the government owing to a lack of risk-related information. Conclusion: Establishing an early warning mechanism through whistleblowing is important for containing risk in the early warning period of public health emergencies. Building the whistleblowing mechanism in daily work can improve the effectiveness of the mechanism and enhance the public's risk perception better when the public health emergencies arise.

Whistle-blower protections for community pharmacists and technicians during COVID-19

Background: International human rights law, in particular Article 7 of the International Covenant on Economic, Social, Cultural Rights, calls for 'just and favourable' work conditions including the 'right to safe working conditions'. COVID-19 has exposed many frontline health workers to unsafe working conditions especially in regard to lack of Personal Protective Equipment (PPE) or protocols to minimise exposure. This further jeopardises not only the health of community pharmacists and technicians but also patients. Purpose(s): Whistle-blower protections ensure that individuals can freely report on substandard and unsafe work conditions without fear of retaliation. However, in many cases, unclear or lack of reporting guidelines for employees, or weaknesses in law and resource limitation of regulatory agencies can prevent or deter reporting. Method(s): This paper will explore the state of whistle-blower protections policies in the United States, in order to analyse the effectiveness of these protections and their uptake in community pharmacy settings. Furthermore, the paper will explore the resources available to pharmacists and technicians who wish to become whistle-blowers or have experienced retaliation as a result of whistleblowing. Result(s): There is a disconnect between protections available, employee understanding and use of these various instruments, enforcement mechanisms, and protection through alternative policies and laws. Conclusion(s): The findings in this paper will be useful for pharmacists and technicians who would like to avail whistle-blower protections and for future research which looks at more effective alternatives to the current whistleblowing protection infrastructure.

GitHub as a collaborative curation platform for memory projects of COVID-19 in China

This study looks at online collaborative memory projects on GitHub, all of which started amid China's war on the then unknown corona virus in early 2020 and curated stories from Chinese language social media, news outlets, and official websites. It finds that GitHub enables a collaborative yet centralized archiving and curation workflow, and each of the three projects present unique ways the COVID-19 memories can be preserved. Three key events – the lockdown of Wuhan, the death of the whistleblowing doctor, and the controversy over Fang Fang's diaries – are further analyzed to show how these memory projects could form narratives that post challenge to the officially sanctioned version of the ‘correct' collective memory.

Food Safety Governance in the Age of COVID-19: How Does Employees' Attitude on Public-Private Governance System Affect Their Willingness to Blow the Whistle on Food Violations?

Online food delivery increases dramatically during the COVID-19 era and has grown into a global marketplace worth more than $150 billion dollars, necessitating a more effective and responsive governance system. Public-private governance systems with whistleblowing to the public are seen as an effective tool for addressing the formidable challenges of food security in modern society. Accordingly, this study aims to explore the determinants of whistleblowing intentions and to propose policy policies for the whistleblowing system to fully utilize the advantages of public-private governance systems. Through empirical research, this paper finds that employees' perceived effectiveness of government authorities, as well as their familiarity with whistleblowing systems, positively affect their intentions to blow the whistle. However, the whistleblowing intent of restaurant employees is adversely affected by the online platform's focus. The root cause lies in the employee's trust in both the government sector and corporate sector. This study thus argues that a suite of measures to promote individual trust in public-private governance systems is desired and that this is an effective means of better mitigating food safety governance challenges in terms of capacity and resources.

GOVERNMENT DISMISSAL AUTHORITY OF FALSE CLAIMS ACT QUI TAM CLAIMS: AN ANALYSIS OF THE CURRENT POLITICAL AND JUDICIAL DEBATE

Dating back to the Civil War, the False Claims Act (FCA) is a powerful weapon that the U.S. government (government) wields to combat fraud. In particular, the FCA contains "qui tam" provisions wherein a whistleblower, known as a "relator," may bring claims in the government's name and retain a portion of any resultant recoveries. While the FCA allows the government to dismiss a qui tam claim notwithstanding the objections of relator, there is a four-way circuit split on the appropriate standard of review for such motions to dismiss. From 2003 through 2020, the split was only between the Ninth Circuit's Sequoia standard, which requires the government to demonstrate the dismissal is rationally related to a valid governmental objective, and the D.C. Circuit's Swift standard, which confers nearly unfettered deference to the government. The year 2020 ushered in a new era of judicial debate with the Seventh Circuit creating a third standard based on the Federal Rules of Civil Procedure and the First Circuit promulgating an entirely different standard-one that requires the government to provide reasons for dismissal. The First Circuit standard also requires dismissal to be granted unless there is a constitutional infirmity or evidence of fraud. This circuit split was thrust into the spotlight in 2018 when Michael Granston, Director of the Department of Justice (DoJ) Commercial Litigation Branch, Fraud Section, promulgated guidance instructing DoJ attorneys to consider dismissing qui tam cases to curb meritless qui tam cases, conserve government resources, and prevent unfavorable precedents. Senator Charles "Chuck" Grassley (R-Iowa), a life-long whistleblower champion, has publicly criticized these dismissals as pretextual and antithetical to the spirit of the FCA. In October 2021, Senator Grassley proposed an FCA amendment that essentially codifies the Sequoia standard. Shortly before this article was sent to the publisher, the Supreme Court granted certiorari to address this question. This article examines the historical context of the qui tam provisions that ultimately gave rise to the circuit split as well as the DOJ's recent use of its dismissal authority. It further evaluates Senator Grassley's proposed FCA amendment and argues that it does not substantively settle key nuanced issues that continue to drive judicial disagreement. In light of the evolution to a four-way circuit split and the recent increase in judicial divergence, this article argues that the government's dismissal authority is well-suited for Supreme Court intervention. Finally, this article examines why the dismissal authority particularly matters now. With a newly emerging circuit split on whether a denied government motion to dismiss can be appealed and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) introducing significant opportunities to commit fraud against the government, it is imperative that all FCA litigants have clarity on the contours of the government's dismissal authority.

The Whistleblower’s Dilemma: An Evolutionary Game Analysis of the Public Health Early Warning System

Although the ability to manage public health emergencies in China has improved significantly, there are still many challenges to the existing information transmission mechanism in pandemic early warning systems. In this context, a tripartite evolutionary game model composed of the local government, the whistleblower, and the public is formulated. By using Matlab, the dynamic evolution path of the game model is stimulated under different conditions. Stable strategies for an early warning system for public health emergencies are also explored. The results indicate that the cost of whistleblowing, the cost of response, and the benefit of attention significantly influence strategic decisions among three parties. This study highlights the importance of whistleblowing in managing public health emergencies. Yet, our findings provide theoretical support for policy recommendations for promoting public health emergency preparedness.

Blowing the whistle during the first wave of COVID-19: A case study of Quebec nurses.

The experiences of nurses who blew the whistle during the COVID-19 pandemic have exposed gaps and revealed an urgent need to revisit our understanding of whistleblowing. AIM: The aim was to develop a better understanding of whistleblowing during a pandemic by using the experiences and lessons learned of Quebec nurses who blew the whistle during the first wave of COVID-19 as a case study. More specifically, to explore why and how nurses blew the whistle, what types of wrongdoing triggered their decision to do so and how context shaped the whistleblowing process as well as its consequences (including perceived consequences). DESIGN: The study followed a single-case study design with three embedded units of analysis. METHODS: We used content analysis to analyse 83 news stories and 597 forms posted on a whistleblowing online platform. We also conducted 15 semi-structured interviews with nurses and analysed this data using a thematic analysis approach. Finally, we triangulated the findings. RESULTS: We identified five themes across the case study. (1) During the first wave of COVID-19, Quebec nurses experienced a shifting sense of loyalty and relationship to workplace culture. (2) They witnessed exceedingly high numbers of intersecting wrongdoings amplified by mismanagement and long-standing issues. (3) They reported a lack of trust and transparency; thus, a need for external whistleblowing. (4) They used whistleblowing to reclaim their rights (notably, the right to speak) and build collective solidarity. (5) Finally, they saw whistleblowing as an act of moral courage in the face of a system in crisis. Together, these themes elucidate why and how nurse whistleblowing is different in pandemic times. CONCLUSION: Our findings offer a more nuanced understanding of nurse whistleblowing and address important gaps in knowledge. They also highlight the need to rethink external whistleblowing, develop whistleblowing tools and advocate for whistleblowing protection. IMPACT: In many ways, the COVID-19 pandemic has challenged our foundational understanding of whistleblowing and, as a result, it has limited the usefulness of existing literature on the topic for reasons that will be brought to light in this paper. We believe that studying the uniqueness of whistleblowing during a pandemic can address this gap by describing why and how health care workers blow the whistle during a pandemic and situating this experience within a broader social, political, organizational context.

Digital dreams have become nightmares: UX for ethical technology use

Digital technologies are essential for learning, health, politics, and commerce. We have innovative products and greater control over the universe. Dangerous physical labor is done by robots. Computational medicine lengthens our life span. And tech supports collaboration and community, essential during the pandemic. Ethical technology use has been expanded by digital heroes such as Tim Berners-Lee, Doug Engelbart, Batya Friedman, Steve Jobs, Alan Kay, J.C.R. Licklider, Ada Lovelace, and Joe Weizenbaum. Yet much is troubling. We depend upon software that nobody fully understands and is vulnerable to cyberterrorism. Privacy has been overrun by governments and surveillance capitalism. Totalitarian control is beyond that envisioned by Bentham with his panopticon and Orwell in 1984. The Internet serves us news matching our prejudices, with an increasing inability to tell true from false. Our children are addicted to their devices, while ubiquitous tech has helped us become workaholics. Jobs are demolished without social safety nets. Digital leviathans threaten to control all commerce. A tech person can become a conscientious objector. Like soldiers refusing to serve in any war or a specific war, this is the refusal to work for a firm or on a project. The distinction between general and selective objection is key. My friend Louis Font, who in 1969 became the first West Point graduate to become a selective conscientious objector and refuse to serve in the Vietnam War, was not objecting to all war. One can object to a specific task or to all work at a firm. The final action is whistleblowing. Whistleblowing occurs when an employee is so convinced of the immorality of a firm's confidential actions that he or she announces to the world what it is doing.

Working for you

Jacqueline Dunkley-Bent, NHS England's chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, wrote to maternity units telling them to "stop using caesarean section rates [for] performance management" and to stop pursuing "normal births", with the targets described as potentially "unsafe" and clinically inappropriate. Even though multiple structures are in place to support staff in raising issues, including the Nursing and Midwifery Council's duty of candour and NHS whistleblowing policies, staff are too often still being ignored and stifled when trying to raise concerns. The RCM guidelines outline situations in which staff should speak up to their line managers and employers, including when staffing levels are unsafe, where leadership support is reduced and when there is pressure to overlook staff concerns. Dr Mary Ross-Davie, RCM director for professional midwifery, urged unvaccinated pregnant women to: "go to trusted, evidence-based sources such as the RCM, RCOG and government websites and talk to healthcare k professionals, including your midwife.

Using Health-Related Behaviour Change Program For Control Of Covid-19 At Workplaces: How It Works

Introduction: The COVID-19 pandemic which is caused by severe acute respiratory syndrome – coronavirus 2 (SARS-CoV-2), has ravaged the world enormously, creating a huge pandemonium among public health, and occupational health and safety authorities. The virus is an enveloped RNA virus, transmitted directly or indirectly via airborne route or contact with contaminated fomites. Studies have shown that transmission occurs rapidly among humans because of poor health – related behaviour frequently exhibited. Although, necessary information on COVID-19 is accessible on all media platforms, the consistent poor response to safety guidelines by individuals at home, public settings and workplaces has aided the prolonged duration of the pandemic. In addition, it has been reported that individuals can be reorientated to behave appropriately via specialized and structured programs. Hence, I hereby propose the use of health – related behaviour change (HRBC) program for control of COVID-19 at workplaces. Materials and Methods: The HRBC program for control of COVID-19 at workplaces requires strict adherence to the following measures: development, implementation, and enforcement of workplace policy for COVID-19;workshops;penalty and reward system;workers engagement via whistleblowing;use of educative videos in eating areas;COVID-19 safety tips in daily toolbox talks;and quarterly performance review. Results: Quarterly review should show increased healthy behaviours and decline in infection rate among employees. Conclusion: HRBC program is the future of workplace measure for control of COVID-19 and other infectious diseases.

Prioritising health to save lives

The NHS, indeed healthcare, is complex, and it might be better if each health professional settled for making a contribution that is achievable, even if small (doi:10.1136/bmj.n3128;doi:10.1136/bmj.n3140).12 But health professionals tend not to settle for doing just enough, as the effort of staff to cope with overstretched health systems makes plain. The debate should be about which public health measures—such as duration of self-isolation (doi:10.1136/bmj.n3164)7—and what type of economic support will ensure health and wellbeing while keeping society “open.” Health professionals in London did just that by setting up a new service that aims to ensure access to healthcare for this underserved population at a time when inequalities are widening (doi:10.1136/bmj.n3069).8 Indeed, a health lens would also help us focus on the inequalities that women still experience, and a new government strategy document is merely a first step (doi:10.1136/bmj.n3142).9 A focus on health and wellbeing outcomes also means listening more to the experiences and insights of health professionals, as well as building the scientific basis for a society worldwide with new priorities.

Corporate Crime and Punishment: An Empirical Study

For many years, law and economics scholars, as well as politicians and regulators, have debated whether corporate punishment chills beneficial corporate activity or, in the alternative, lets corporate criminals off too easily. A crucial and yet understudied aspect of this debate is empirical evidence. Unlike most other types of crime, the government does not measure corporate crime rates;therefore, the government and researchers alike cannot easily determine whether disputed policies are effectively deterring future incidents of corporate misconduct. In this Article, we take important first steps in addressing these questions. Specifically, we use three novel sources as proxies for corporate crime: the Financial Crimes Enforcement Network (FinCEN) Suspicious Activity Reports (SARs), consumer complaints made to the Consumer Financial Protection Bureau (CFPB), and whistleblower complaints made to the Securities and Exchange Commission (SEC). Each source reveals an increase in complaints or reports indicative of corporate misconduct over the past decade. We also examine levels of public company recidivism and find that they are likewise on the rise. And we document a potential explanation: recidivist companies are much larger than nonrecidivist companies, but they receive smaller fines than non-recidivist companies (measured as a percentage of market capitalization and revenue). We conclude by offering recommendations for enforcement agencies and policymakers. In particular, our results suggest that enforcers are unlikely to achieve optimal deterrence using fines alone. Enforcement agencies should therefore consider other ways of securing deterrence, such as by seeking penalties against guilty individuals and the top executives who facilitate their crimes.

Medical Education for What?: Neoliberal Fascism Versus Social Justice.

In her 2018 book, What the Eyes Don't See, Dr. Mona Hanna-Attisha wrote that it is the duty of doctors to speak out against injustice. In fact, no other physician or institution in Flint had done the research and spoken out, as a whistleblower, against the poisoning of Flint's children by Michigan government. Why had Dr. Hannah-Attisha? Unfortunately, in the absence of a medical education system that teaches community-oriented primary health care in the tradition of the 1978 Alma Ata Declaration, there is little reward in doing so. This article focuses on three movements that are challenging medical education orthodoxy: 1) primary health care 2) the medical humanities and 3) "Study Up your Town" medicine. How can we create a radical health pedagogy - one that draws the links between several pandemics raging across the planet: capitalist collapse, climate disruption, Covid-19, racism, and an emergent neoliberal fascism - to enable doctors, health professionals and citizens to see them as all of one piece? Medical educators must employ critical pedagogy to create legions of "constructive troublemakers" who challenge the social-structural obstacles that are driving millions to premature death. We have reached the "end times." A new "planet medicine" is finally emerging.

Humiliating Whistle-Blowers: Li Wenliang, the Response to Covid-19, and the Call for a Decent Society.

The ethical experience and lessons of China's and the world's response to COVID-19 will be debated for many years to come. But one feature of the Chinese authoritarian response that should not be overlooked is its practice of silencing and humiliating the whistle-blowers who told the truth about the epidemic. In this article, we document the humiliation of Dr Li Wenliang (1986-2020), the most prominent whistle-blower in the Chinese COVID-19 epidemic. Engaging with the thought of Israeli philosopher Avishai Margalit, who argues that humiliation constitutes an injury to a person's self-respect, we discuss his contention that a decent society is one that abolishes conditions which constitute a justification for its dependents to consider themselves humiliated. We explore the ways that institutions humiliate whistle-blowers in Western countries as well as in China.