Description
Instructions: Please read the following case and answer the questions outlined below. Please complete the exam in a .doc file or pdf and upload it to Sakai when it is complete. Exams must use a recognized citation system – e.g. MLA – and must be double-spaced throughout. Although this is an open book exam, it is not advisable to simply cut and paste from the lecture slides. You need to demonstrate that you understand the concepts and principles being employed and so it is best to put things in your own words. It’s fine to use direct quotes, but make sure you explain them in your own words.
Case: For a number of years, U.S. states, cities, and public health advocates have repeatedly petitioned the federal government to either reform the Supplemental Nutrition Assistance Program (SNAP) to prohibit the use of SNAP benefits to purchase sugar-sweetened beverages (SSBs), or to authorize a pilot study evaluating the effects of such a prohibition. SSBs are the largest single source of added sugar in Americans’ diets, and proponents of the proposed reform see it as an effective way to lower the prevalence of obesity and chronic diseases associated with SSB consumption, including type 2 diabetes and heart disease.
Suppose that the U.S. Department of Agriculture authorizes the North Carolina Department of Health and Human Services to conduct a randomized controlled trial in Raleigh, evaluating the effects of a SNAP-specific SSB ban on SNAP recipients’ consumption behavior. 5000 SNAP recipients in Raleigh would be randomly assigned to be subject to this intervention, meaning they would not be permitted to use their SNAP benefits to purchase SSBs. 5000 SNAP recipients would be randomly assigned to continue being subject to the current SNAP policy. Data regarding consumption behavior would be drawn from voluntary surveys with participants and retailers participating in SNAP, and from electronic benefits transfer (EBT) card transaction data (ETB cards, akin to debit cards, are the principal way recipients use their SNAP benefits). Participants would not be asked to consent to participation in the study but would be notified of their enrollment prior to the start of the experiment. For example, SNAP recipients assigned to the experimental intervention would be notified that due to their enrollment in a pilot study, they would not be able to purchase SSBs with their EBT cards for the duration of the study.
Questions:
- State officials plan to evaluate the SNAP-specific SSB ban using a randomized controlled trial (RCT). What is the principle of policy equipoise? What is the justification for it? What would have to be the case for the planned RCT to satisfy the principle of policy equipoise?
- In the context of the planned RCT, SNAP recipients will not be asked to give informed consent to participation in the study. What is informed consent? In your view, does the fact that the planned RCT does not secure people’s informed consent mean that it is unethical? Why or why not?
- The proposed SNAP-specific SSB ban prohibits SNAP recipients from purchasing SSBs with SNAP benefits. What is the harm principle? Does this policy violate the harm principle? Why or why not?
- Suppose that the RCT is carried out and demonstrates convincingly that a SNAP-specific SSB ban is effective at lowering SNAP recipients’ overall consumption of SSBs (and does not lead recipients to substitute other sugary items – e.g. chocolate bars – for SSBs). Should the North Carolina Department of Health and Human Services petition the U.S. Congress to make the ban permanent for all SNAP recipients in North Carolina? Why or why not?
Explanation & Answer
Attached.
Running Head: SNAP
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Case Study: SNAP
Name
Institution
SNAP
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The supplemental nutrition assistance program (SNAP) was implemented by the federal
government to help low-income families in the US access affordable food and fight hunger. In
this case, the program offers families the nutritional needs they require during hard times to help
them get up on their feet. According to Watson (2019), the SNAP program benefits over 40
million Americans allowing children to get a chance towards healthy adulthood and ensuring that
the elderly age gracefully with dignity. Despite the efforts by the government to fight hunger,
SNAP lacks nutritional standards on the foods that one can buy with the electronic benefits
transfer card (EBT). This has resulted in increased intake and purchase of junk foods, including
chips, candy, cakes, as well as sugar-sweetened beverages (SSBs). According to Negowetti
(2018), there are concerns that increased intake of SSBs contributes greatly to public health
problems resulting in higher cases of obesity, diabetes type 2, and cardiovascular problems,
among others. In this paper, I will discuss the ethical considerations that should accompany
randomized controlled trials regarding the impact of banning or limiting the use of SNAP
benefits for the purchase of SSBs.
Question 1: Principle of Equipoise
The principle provides the ethical basis for research involving assigning different
interventions to patients or a population in a randomized trial. In this case, the principle of
equipoise provides that the policy experts should genuinely be uncertain on whether a given
intervention will be beneficial to the subjects (Mackay, 2018). This means that research should
only be conducted if there is uncertainty on the relative value of arms being compared in a trial.
According to Ubel & Sibergleit (2011), a trial should begin with a genuine null hypothesis
without existing evidence to show that one intervention is superior or ineffective than the other.
SNAP
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In the case of the planned RCT, the principle of equipoise would be satisfied if all the
arms of the policy are at a minimum. This means that there needs to be high uncertainty whether
the current SNAP program allowing the purchase of SSBs increases the burden of obesity and
other diseases associated with unhealthy food choices....