Anti-Governance of the Deed

Unintended Consequences of Health Care Legislation

The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry

Safety and nutritional assessment of GM plants and derived food and feed: The role of animal feeding trials

The unintended consequences of computerized provider order entry: Findings from a mixed methods exploration

BackgroundHealth systems are increasingly implementing policy-driven programs to incentivize performance using contracts, scorecards, rankings, rewards, and penalties. Studies of these “Performance Management” (PM) programs have identified unintended negative consequences. However, no single comprehensive typology of the negative and positive unintended consequences of PM in healthcare exists and most studies of unintended consequences were conducted in England or the United States. The aims of this study were: (1) To develop a comprehensive typology of unintended consequences of PM in healthcare, and (2) To describe multiple stakeholder perspectives of the unintended consequences of PM in cancer and renal care in Ontario, Canada.MethodsWe conducted a rapid review of unintended consequences of PM in healthcare (n = 41 papers) to develop a typology of unintended consequences. We then conducted a secondary analysis of data from a qualitative study involving semi-structured interviews with 147 participants involved with or impacted by a PM system used to oversee 40 care delivery networks in Ontario, Canada. Participants included administrators and clinical leads from the networks and the government agency managing the PM system. We undertook a hybrid inductive and deductive coding approach using the typology we developed from the rapid review.ResultsWe present a comprehensive typology of 48 negative and positive unintended consequences of PM in healthcare, including five novel unintended consequences not previously identified or well-described in the literature. The typology is organized into two broad categories: unintended consequences on (1) organizations and providers and on (2) patients and patient care. The most common unintended consequences of PM identified in the literature were measure fixation, tunnel vision, and misrepresentation or gaming, while those most prominent in the qualitative data were administrative burden, insensitivity, reduced morale, and systemic dysfunction. We also found that unintended consequences of PM are often mutually reinforcing.ConclusionsOur comprehensive typology provides a common language for discourse on unintended consequences and supports systematic, comparable analyses of unintended consequences across PM regimes and healthcare systems. Healthcare policymakers and managers can use the results of this study to inform the (re-)design and implementation of evidence-informed PM programs.

Exaggerating unintended effects? Competing narratives on the impact of conflict minerals regulation

Unintended adverse consequences of introducing electronic health records in residential aged care homes

The fear of unintended consequences is frequently used to argue against conservation interventions that range from climate engineering, to genetic editing of imperiled species, to actions as seemingly mundane as using seeds from non-local sources in restoration projects. There is no denying that unintended consequences are real and worthy of concern. Indeed, environmental textbooks are filled with descriptions of past interventions gone awry (such as the introduction of cane toads to Australia for biocontrol, the impacts of long-term wildfire suppression, or the use of DDT to control insect pests). However, there are also numerous counterexamples of interventions turning out as planned (for instance, barging salmon smolts around Snake River dams and human-assisted hybridization rescuing the depleted gene pool of Florida panthers). For actions under consideration, the question is how to weigh the possible unintended consequences versus the highly likely intended benefits. A June 2020 workshop (https://reviv​erest​ore.org/inten​ded-conse​quences), organized by Revive & Restore, assembled an international group of conservationists (including wildlife biologists, restoration scientists, geneticists, ethicists, and social scientists) to re-examine the precautionary principle and its associated focus on unintended and unanticipated consequences. Two observations make apparent the need for this reassessment. First, accelerating anthropogenic climate change and the expanding human footprint create ever-greater urgency for actions that could avert disasters or prevent human-driven extinctions. With most rivers dammed, a nitrogen cycle dominated by human alterations, and such severe global warming that within 50 years as many as one in three humans could be forced to migrate in search of a habitable environment (https://nyti.ms/2E5a0Wi), conservationists do not have the luxury of “doing nothing” out of fear of unintended consequences. Caution is prudent, but paralysis is unconscionable. Second, the science of risk assessment has advanced so that, although it is impossible to eliminate uncertainty, the likelihood of horrific ecological surprises is much less now than in previous decades. Ecologists today better understand ecosystems and indirect effects than they did in the 1960s and 1970s when several well-intended, but ill-fated, introductions were conducted (eg introducing the American red squirrel to Newfoundland to augment the diet of pine martens; introducing the seed weevil Rhinocyllus conicus to control exotic thistles in North America). Lessons learned with each intervention reduce the chance for future errors. Not only is risk assessment improving, but some of the tools for intervention are becoming refined. For example, the genomic and phenotypic changes that result from gene editing are much more precise than those wrought by more widely accepted techniques like hybridization and mutagenesis. Obviously, the answer is not to blithely ignore unintended consequences and adopt an “anything goes” attitude. However, it is time to recalibrate our traditional cautionary approach to environmental decision making with fine-tuning in four dimensions. First, the intended consequences of proposed interventions must carry more weight in analyses. Consider the public debate over transgenic Bt crops. The intended benefit of reducing the application of broadly toxic insecticides has largely been overshadowed by fears of environmental harms, for which there is no convincing evidence. Second, scientists should avoid being overly influenced by examples of disaster from generations ago and give more credit to recently accumulated empirical evidence. From reintroductions to genetic rescues, the vast majority of contemporary environmental interventions have produced their intended positive outcomes, yet a few historical cases of problematic outcomes continue to dominate public perception. Moreover, all actions, including inaction, entail the potential for unintended consequences. For instance, growing evidence shows that protected area creation – an intervention largely embraced by conservationists – typically displaces, rather than curtails, environmental harms and can prove counterproductive if local communities are alienated. Third, risk assessment relies on tools ranging from controlled experiments and practical experience to models and simulations. All of these tools help characterize risk, but empirical data should be far more reassuring than theoretical, but untested, models. Thirty years of globally widespread Bt crops with no ill-effects ought to inspire confidence, whereas speculative interventions such as solar geoengineering warrant greater precaution. Lastly, and most importantly, scientists need to recognize that the worst unintended consequences may not be environmental or ecological, but rather social. A carbon tax might be a great way to reduce greenhouse-gas emissions and a protected area may secure a remnant population of a declining species, but such actions disproportionately impose costs on marginalized human communities. A wider variety of voices must be invited to weigh in on what intended outcomes are desired, and how best to achieve them. While risk reduction efforts now better recognize and minimize unintended environmental harms, much work remains to address unintended social and cultural consequences. MICHELLE MARVIER Santa Clara University, Santa Clara, CA PETER KAREIVA Aquarium of the Pacific, Long Beach, CA

With the emergence of SARS-CoV-2 in late 2019, governments worldwide implemented a multitude of non-pharmaceutical interventions in order to control the spread of the virus. Most countries have implemented measures within the school setting in order to reopen schools or keep them open whilst aiming to contain the spread of SARS-CoV-2. For informed decision-making on implementation, adaptation, or suspension of such measures, it is not only crucial to evaluate their effectiveness with regard to SARS-CoV-2 transmission, but also to assess their unintended consequences. To comprehensively identify and map the evidence on the unintended health and societal consequences of school-based measures to prevent and control the spread of SARS-CoV-2. We aimed to generate a descriptive overview of the range of unintended (beneficial or harmful) consequences reported as well as the study designs that were employed to assess these outcomes. This review was designed to complement an existing Cochrane Review on the effectiveness of these measures by synthesising evidence on the implications of the broader system-level implications of school measures beyond their effects on SARS-CoV-2 transmission. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, four non-health databases, and two COVID-19 reference collections on 26 March 2021, together with reference checking, citation searching, and Google searches. We included quantitative (including mathematical modelling), qualitative, and mixed-methods studies of any design that provided evidence on any unintended consequences of measures implemented in the school setting to contain the SARS-CoV-2 pandemic. Studies had to report on at least one unintended consequence, whether beneficial or harmful, of one or more relevant measures, as conceptualised in a logic model. DATA COLLECTION AND ANALYSIS: We screened the titles/abstracts and subsequently full texts in duplicate, with any discrepancies between review authors resolved through discussion. One review author extracted data for all included studies, with a second review author reviewing the data extraction for accuracy. The evidence was summarised narratively and graphically across four prespecified intervention categories and six prespecified categories of unintended consequences; findings were described as deriving from quantitative, qualitative, or mixed-method studies. Eighteen studies met our inclusion criteria. Of these, 13 used quantitative methods (3 experimental/quasi-experimental; 5 observational; 5 modelling); four used qualitative methods; and one used mixed methods. Studies looked at effects in different population groups, mainly in children and teachers. The identified interventions were assigned to four broad categories: 14 studies assessed measures to make contacts safer; four studies looked at measures to reduce contacts; six studies assessed surveillance and response measures; and one study examined multiple measures combined. Studies addressed a wide range of unintended consequences, most of them considered harmful. Eleven studies investigated educational consequences. Seven studies reported on psychosocial outcomes.Three studies each provided information on physical health and health behaviour outcomes beyond COVID-19 and environmental consequences. Two studies reported on socio-economic consequences, and no studies reported on equity and equality consequences. We identified a heterogeneous evidence base on unintended consequences of measures implemented in the school setting to prevent and control the spread of SARS-CoV-2, and summarised the available study data narratively and graphically. Primary research better focused on specific measures and various unintended outcomes is needed to fill knowledge gaps and give a broader picture of the diverse unintended consequences of school-based measures before a more thorough evidence synthesis is warranted. The most notable lack of evidence we found was regarding psychosocial, equity, and equality outcomes. We also found a lack of research on interventions that aim to reduce the opportunity for contacts. Additionally, study investigators should provide sufficient data on contextual factors and demographics in order to ensure analyses of such are feasible, thus assisting stakeholders in making appropriate, informed decisions for their specific circumstances.

This article describes the ways in which socioeconomic characteristics and workplace contexts shape the unintended consequences that cancer survivors can experience as they return to work. The study was conducted in an employment setting where there is a major focus on productivity and economic growth in the business sector. Five focus groups (N = 33 participants) were conducted in 2012 in Singapore. Questions were directed at obtaining information related to the meaning of a job and reactions to return to work as a cancer survivor completes primary cancer treatment. A thematic analysis using a two-staged analytical process was conducted to identify (1) work-related challenges faced by survivors as a result of the interplay between their self-identity as someone with a critical illness and organizational structure, and (2) unintended social consequences (USCs) related to the interaction between the workplace and cancer survivor. Eight emerging themes of work-related challenges and unintended consequences were categorized. Fear of losing out by compromising one's expectation, downplaying illness to avoid being a burden to others, working harder to meet expectations, and passive acceptance to perceived discrimination. Unintended consequences were also observed in relation to policies, procedures, and economic factors in the context of a heightened economically driven social climate. This study contributes to the understanding of how cancer survivors perceive their work situation. These findings can inform health care providers, employers, and policy makers regarding the challenges faced by cancer survivors as they return to the workplace in a culture of a rapidly growing emphasis on economic concerns. These findings offer a new perspective on the complexities that can occur when cancer survivors interact with their workplace. Awareness of the existence and types of unintended consequences in this context can help provide a more comprehensive understanding of the cancer survivor and work interface.

Why is it that so many economic policies constantly fall short of their initial intended goals? In the social sciences, unintended consequences are outcomes of a purposeful action that are not intended or foreseen. The law of unintended consequences refers to how economic decisions may have effects that are unexpected. Adam Smith's “invisible hand,” is an example of a positive unintended consequence. For instance, the U.S. government has imposed quotas on imports of steel in order to protect steel companies and steelworkers from the lower-priced competition. But they also make less of the cheap steel available to U.S. automakers. As a result, the automakers have to pay more for steel than their foreign competitors do. In Korea, the towns which adopted the suicide prevention law failed to mitigate the suicide rate or even worsening it. In the state of Maharashtra India, the implementation of the family planning program resulted in strong son preference result in an adverse sex ratio in the state. Daniel Ellsberg's (1972) critique of the “quagmire model,” for U.S.catastrophic entanglement in the Vietnam War. Some Sub-Saharan African countries use agrochemicals that increased the value of harvest but are also associated with increasing costs of human illness. Economic effects of 1929 U.S. Prohibition were largely negative, eliminated thousands of jobs, with one of the unintended economic consequences of Prohibition, was on decreasing government tax revenues. 2010 U. S. Dodd-Frank Act discouraging companies from sourcing 'conflict minerals' from the eastern Democratic Republic of the Congo increased the probability of infant deaths in villages near the regulated ‘conflict mineral’ deposits by at least 143 percent. The law of unintended consequences rarely defined, is that actions of people (especially of government) always have effects that are unintended. In 1692 the English philosopher John Locke urged a parliamentary bill designed to cut the interest from 6 percent to 4 percent that instead of benefiting borrowers, as intended, it would hurt them. French economic journalist Frederic Bastiat distinguished the seen were the obviously visible consequences of an action or policy. The unseen were the less obvious unintended, consequences. In 1936 by the American sociologist, Robert K. Merton recognized five sources of unanticipated consequences. I am adding the sixth source and refer to it as the Effect. The Coriolis force, named after French mathematician Gaspard Gustave de Coriolis (1792–1843). In 1835, Coriolis derived the expression of a force acting in rotating systems, now known as the Coriolis force. Scientists have invented an imaginary clockwise circulation force, called the Coriolis force, to account for the Coriolis effect. In the 1870s, a handful of committed economists hoped to make economics a science as highly regarded as physics applied by Newton’s physical laws of motion to economic science. When Newton's laws are modified to a rotating frame of reference, the Coriolis and moving or tending to move away from a center increase in speeds appear. The Coriolis force minutely changes the direction of a bullet, affecting accuracy at, particularly long distances. At the gridline of Sacramento, California, a 1,000 yd (910 m) northward shot would be deflected 2.8 in (71 mm) to the right. Negative unintended consequences repeatedly become visible when a simple regulation is imposed on a complex system. Given the complexity of physical, social, and economic systems, negative unintended consequences are likely to come out and to be notable. Thus, policymakers should also be aware of the “Coriolis Force” phenomenon while calculating their economic policies due to Force could deflect the direction of intended policy to unwanted and unpredicted results for the economy.

“Unintended consequences” is a taken-for-granted narrative used to refer to the effects of a policy that overflow the original intended effect. In drug policy scholarship, “unintended consequences” is used to call for better and more accountable decision making. In this article, I draw from sociology, science and technology studies, and policy anthropology to consider the political decisions that underpin “unintended consequences.” I elaborate the relationships between choice, intent, interest, and unintended versus unanticipated consequences before considering the case example of police diversion in NSW, Australia. While drug policy decisions are taken without assurances of the outcomes, I argue that effects that are known or expected should not be referred to as “unintended consequences.” Instead, I argue that reframing these effects as “politically acceptable effects” allows closer attention to policy choice and the political calculations that underpin it.

ObjectiveTo identify patient-safety-related unintended consequences of healthcare technologies experienced by their primary users: patients, carers and healthcare providers (HCPs).DesignQualitative study based on data collected in online focus groups. Transcripts were...

Intravenous drug use and HIV: evidence for action now

Types of Unintended Consequences Related to Computerized Provider Order Entry