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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:

  1. 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?
  2. 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?
  3. 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?
  4. 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?

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