News

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African Americans, Latinos Less Likely to Enroll in HIV Clinical Trials

"Race and ethnicity influence access to research trials and experimental therapies," said lead author Allen Gifford, of the U.S. Department of Veterans Affairs San Diego Healthcare System and the University of California, San Diego. "Even when whites and minorities had the same amount of education, type of health insurance, and degree of illness, whites were about twice as likely to be enrolled in research trials as were minorities."

According to the study, whites were more than twice as likely as black patients to try to obtain an experimental medication—and were slightly more likely to succeed. Among patients who said they actively sought out experimental drugs, 77 percent of whites (but 69 percent of blacks) received them.

"The underrepresentation of some groups among those getting experimental treatments is a problem for two reasons," said the study's senior author, Sam Bozzette, of RAND; the University of California, San Diego; and the Veterans Affairs San Diego Healthcare System.

"First, clinical trials are most useful in guiding future medical care if the patients enrolled in them are similar to those who will use the new treatment once it is released. Second, the use of experimental treatments outside of clinical trials should be equally available to all those who need them."

Pakistani General Looks East, West for Help

Khan asserted that Pakistan's nuclear program is inextricably tied to its security. The country's threats include an unstable Afghanistan to the west, internal turmoil, and a hostile India to the east.

The United States and China, he said, could be instrumental in bringing peace to the region. He suggested that the United States and China could create a basic code of conduct, agreed upon by Pakistan and India. Such conduct would require immediate consultations among the four countries during crisis situations.

He added that Pakistan and India should commit to refrain from using, or threatening to use, force against each other. Finally, he proposed the creation of a program to guard against accidental or unauthorized use of nuclear weapons.

Ultimately, Khan said, a doctrine of nuclear deterrence based on the concept of "mutually assured accommodation" would be the most viable path for peace in South Asia.

Russian Corruption

These are some of the findings of Georgiy Satarov, founder and president of the INDEM Foundation, an independent center of policy analysis and research in Russia.

Satarov, who spoke recently at RAND, interviewed businessmen and private individuals in Russia. The private individuals were first asked if they had ever found themselves in a situation where they were asked to pay a bribe (monetary or nonmonetary) and, if so, whether or not they paid it. Almost 40 percent of total respondents reported they had paid the bribe.

Satarov also discovered that the biggest market for corrupt services was within the university system. He said that corrupt services represented just under $445 million of the system's total estimated $2.8 billion annual market—or almost 16 percent of the market. Enrolling in college to avoid military service was a top motivator for men to offer bribes.

Businessmen were more reluctant to admit to "giving any kind of incentive" (or bribe) to government officials. Still, the researchers found that over 66 percent of businessmen offered such bribes.

Satarov estimated that the annual total dollar figure of bribes paid by businesses was over $33 billion in 2001. The federal budget of Russia in 2001 was $40 billion.

California: A Proving Ground for U.S. Policies?

Many future national policy challenges are already becoming evident in California, with its exceptionally large and diverse population. According to RAND researchers, major national policy challenges over the coming decade will include balancing competing interests within ethnically diverse areas, nurturing human capital for the nation's scientific pursuits, and addressing impediments to individual opportunity, including educational disparities and remnants of a "digital divide." See below for projections of U.S. demographic diversity through 2050.

America's Changing Ethnic Diversity

America's population will become increasingly diverse. The changing demographics will have implications for many public policies, such as affirmative action, early childhood investments, housing, health care, criminal justice, and civil rights laws.

A Call to Action Against Childhood Asthma

A panel of health experts recently called for policy changes to improve asthma care for children.

An estimated five million children in the United States live with asthma, the most common chronic childhood illness in the country, according to a RAND report recently published in the journal Pediatrics. Among U.S. children under age five, the number of cases has increased 160 percent between 1980 and 1994. African Americans and some Latinos, particularly Puerto Ricans, suffer the highest asthma rates.

"Although children with asthma can live normal lives when they receive effective treatment, too many children with asthma are suffering unnecessarily, and some are even dying," said Marielena Lara, lead author. "This report is a call to action to leaders in the public and private sectors to make substantial, coordinated efforts to solve this problem."

The proposed actions include expanding insurance coverage and benefits for children with asthma and creating "asthma-friendly" communities and policies. Such efforts would include more quickly diagnosing asthma; better equipping health care facilities, schools, and social agencies; and ensuring that children are safe from risks that exacerbate the condition.

Additional recommendations are meant to strengthen the public health infrastructure. These include the development of a national asthma surveillance system, which would expand the roles of private and public stakeholders at the local, state, and federal levels.

Class Size Matters

It's hard to say if California's program to reduce the size of kindergarten through third-grade classes is responsible for increases in student test scores, but the program is highly popular anyway, says a consortium of researchers evaluating the program for the California Department of Education.

While achievement scores have risen significantly in California's elementary schools in the past five years—the same period when the Class Size Reduction (CSR) program was implemented—the researchers found little evidence that CSR had played a significant role in the rise.

In spite of their inconclusive findings, the researchers noted that CSR remains highly popular among parents and teachers in California, where elementary school classes were among the largest in the country prior to CSR.

"Parents and teachers overwhelmingly feel that smaller is better," said Brian Stecher, a researcher at RAND, which is a member of the consortium. "In part, this may be due to students getting more individual attention in smaller classes and teachers feeling they know their students better and can better respond to their needs."

While class size reduction is likely to remain a priority for the state, the researchers have suggested improvements. One is to create incentives for some districts to experiment with variations of CSR as a way to meet local needs and to gain knowledge about the cost-effectiveness of alternative class-size arrangements for different student populations.

Harvard Business Scholar Asks: "Globalization for Whom?"

AP/WIDEWORLD PHOTOS/TEH ENG KOON An investor reads a local newspaper and studies the share index at a private stock gallery in Kuala Lumpur, Malaysia.

Popular economic theory holds that globalization should help poor countries get richer. The problem, according to Bruce Scott, professor at Harvard Business School, is that popular economic theory works best in rich countries.

Speaking recently at RAND, Scott contended that the golden opportunities of globalization glitter for only about 15 percent of the world's population. So rich countries get richer, and Third World countries are little or no better off.

The key to a country's wealth, he said, is the integrity of a country's underlying social structures and government institutions—such as democratic elections, educational systems, and judicial systems. Such foundations uphold economic markets, not the reverse. Economic theory works where the foundations are already in place.

He challenged the notion that disadvantaged countries could compete on an even playing field with advantaged countries. "It's equivalent to saying, 'We all know how to play cards.' But the Third World is playing 'go fish,' and the rich countries expect everyone to know how to play bridge. Globalization creates opportunities only if you have the foundations. If all you can do is play 'go fish,' it does you no good to get invited to a bridge game. For much of the world, those are the circumstances."

The stakes appear to be growing as markets become more sophisticated and globalized. According to Scott, part of the problem is that rich countries insist on barriers to immigration and to agricultural imports. Another part of the problem is that most poor nations have been unable to attract much foreign capital due to their own government failings.

"By forcing poor people to remain in badly governed states, immigration barriers deny those most in need of the opportunity to 'move up' by 'moving out.'"

Scott also rejected the notion that low labor costs offer the best opportunities for people in poor countries. "If the rest of the system doesn't work, the labor advantage doesn't matter much."

Even if a country musters popular support to modernize its institutional foundations, it takes ongoing and accountable political authority to keep the systems humming. The age-old predicament with political authority, Scott said, is keeping it accountable over the long term.

"Sovereignty is a funny problem for poor countries," said Scott. "You can be a lousy manager of a country with little to fear [from the rest of the world] unless you get caught committing genocide, human rights violations, or bombing lower Manhattan."

The disadvantage of globalization is most acute for Muslim countries, where religious and cultural values hinder the formation of more effective institutions, said Scott. He argued that Muslim countries generally do not revamp their laws and institutions without going back to the Koranic scriptures to "rediscover what the law was."

For poor Muslim countries, Scott offered one source of reform: Increase the skills, not just the incomes, of the low-skilled part of the population. He also noted that the best way for the United States to promote reform in some Muslim countries would be to highlight existing and successful examples of reform in other Muslim countries.

One model is Malaysia, a relatively savvy, higher-income Muslim country. "The Malays have been really sophisticated in trying to avoid a confrontation with [Islamic] fundamentalists. It would be a whole lot easier to have Muslims from Malaysia say, 'Look at us. We can do this, and we're still Muslims.'"

Otherwise, said Scott, the writing is on the wall. "If Americans don't pay more attention to the difficulties of poor countries, I think we are likely to become targets for terrorists in many, many countries."