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Some of the worst human rights catastrophes of the twentieth century were famines created or manipulated by governments. In 1932 at least five million Ukrainians starved to death, while hunger was largely unknown across the border in Russia.The Soviet government imposed disastrous grain quotas on the Ukraine, then let its own citizens literally collapse in the streets while it exported grain to further its “revolutionary” objectives.The Ethiopian famine of 1983-1985, preserved in popular memory as a natural disaster of biblical proportions, most fiercely struck those parts of the country that harbored irredentist movements. In a stunning, but telling, rejoinder to international pity for the purportedly hapless Ethiopian government, the Ethiopian foreign minister told a U.S. chargé d’affaires that “food is a major element in our strategy against the secessionists.” Since 1994, more than two million out of a population of twenty-two million in North Korea have starved to death, while South Koreans, affected by similar weather patterns, have remained completely untouched by famine. Nongovernmental organizations (NGOs), trying to distribute aid earmarked for famine victims, have watched helplessly as the government callously interfered and have arrived at the conclusion that “the authorities are deliberately depriving hundreds of thousands of truly needy Koreans of assistance.”

BackgroundDesign thinking (DT) is a tool for generating and exploring ideas from multiple stakeholders. We used DT principles to introduce students to the ethical implications of organ transplantation. Students applied DT principles to propose solutions to maximise social justice in liver transplant allocation.MethodsA 150 min interactive workshop was integrated into the longitudinal ethics curriculum. Following a group didactic on challenges of organ donation in the USA supplemented by patient stories, teams of students considered alternative solutions to optimise fairness of organ distribution and ethical implications of changing the current model. Facilitators led students through DT steps of empathy, defining the team’s point of view, ideating on potential solutions, prototyping a specific idea and testing the idea through oral presentation, with questions and answers by peers and faculty. The curriculum was evaluated with presurveys and postsurveys including quantitative and open-ended items.Results100 first year medical students participated. Before the session, 75.3% of students had no practical experience with DT. Following participation, students reported an increased understanding of the current liver transplant allocation system (p<0.01) and an increased appreciation of shortcomings of the current organ allocation system (p<0.01). After the session, 73.8% of students felt that DT could be used to approach complex health system problems.DiscussionStudents participating in a DT workshop displayed improved knowledge and attitudes toward organ transplantation and DT. In this pilot study, DT showed promise as a student-led approach emphasising collaboration and creativity in ethics curricula in medical education.

"The literature of the 1990s and early 2000s was a catchall of voices and styles: experimental and staid, high and low, monumental and grotesque—often all at once. While an older generation of novelists—Peter Carey and Philip Roth, J.M. Coetzee and Ian McEwan, Toni Morrison and Barry Unsworth—retreated to history, choosing to fictionalize the past rather than be consumed by the present, a new group of avant gardists—Richard Powers, David Foster Wallace, Dave Eggers, and Zadie Smith—tried their hand at the now. Inspired by the speculative fiction of Thomas Pynchon and Don DeLillo, they sought to write the next BIG NOVEL: fiction capacious enough to contain the wide girth of post-Cold War capitalism. But if the literature of the turn of the twentieth century appeared to be a frenzy of new voices and styles, it was also oriented toward a common goal. For unlike their predecessors, this new generation sought to rebuild the world rather than deconstruct it."

We study a unique natural experiment, during which 5-10% of draft opinions by judges of the Board of Veterans Appeals (BVA) were randomly selected for "quality review" by a team of full-time staff attorneys for nearly 15 years. This performance program had the express goals of measuring accuracy and reducing reversal rates on appeal. In cases of legal error, the quality review team wrote memoranda to judges to permit correction before opinions were issued. We use rich internal administrative data on nearly 600,000 cases from 2002-2016 to provide the first rigorous study of this review process. With precise estimates, we show that the program had no appreciable effect on reducing appeals or reversals. Based on internal records, we demonstrate that this inefficacy is likely by design, as meeting the performance measure of "accuracy" was at cross-purposes with error correction. These findings inform longstanding questions of law, organization, and bureaucracy, including performance management, standards of review, and the institutional design of mass adjudication.