Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Monday, March 18, 2024

Mega Malpractice Verdicts Against Physicians on the Rise

Alicia Gallegos
MedScape.com
Originally posted 2 Feb 24

Here is an excerpt:

Why Are Juries Awarding Higher Verdicts?

There's no single reason for the rise in nuclear verdicts, Henderson said.

One theory is that plaintiffs' attorneys held back on resolving high-dollar cases during the COVID pandemic and let loose with high-demand claims when courts returned to normal, he said.

Another theory is that people emerged from the pandemic angrier.

"Whether it was political dynamics, masking [mandates], or differences in opinions, people came out of it angry, and generally speaking, you don't want an angry jury," Henderson said. "For a while, there was the halo effect, where health professionals were seen as heroes. That went away, and all of a sudden [they] became 'the bad guys'."

"People are angry at the healthcare system, and this anger manifests itself in [liability] suits," added Bill Burns, vice president of research for the Medical Professional Liability Association, an industry group for medical liability insurers.

Hospital and medical group consolidation also reduces the personal connection juries may have with healthcare providers, Burns said.

"Healthcare has become a big business, and the corporatization of medicine now puts companies on the stand and not your local community hospital or your family doctor that you have known since birth," he said.

Plaintiffs' attorneys also deploy tactics that can prompt higher verdicts, White said. They may tell a jury that the provider or hospital is a threat to the community and that awarding a large verdict will deter others in the healthcare community from repeating the same actions.

Juries may then want to punish the defendant in addition to assessing damages for economic harm or pain and suffering, White said.

Sunday, March 17, 2024

The Argument Over a Long-Standing Autism Intervention

Jessica Winter
The New Yorker
Originally posted 12 Feb 24

Here are excerpts:

A.B.A. is the only autism intervention that is approved by insurers and Medicaid in all fifty states. The practice is widely recommended for autistic kids who exhibit dangerous behaviors, such as self-injury or aggression toward others, or who need to acquire basic skills, such as dressing themselves or going to the bathroom. The mother of a boy with severe autism in New York City told me that her son’s current goals in A.B.A. include tolerating the shower for incrementally longer intervals, redirecting the urge to pull on other people’s hair, and using a speech tablet to say no. Another kid might be working on more complex language skills by drilling with flash cards or honing his ability to focus on academic work. Often, A.B.A. targets autistic traits that may be socially stigmatizing but are harmless unto themselves, such as fidgeting, avoiding eye contact, or stereotypic behaviors commonly known as stimming—rocking, hand-flapping, and so forth.

(cut)

In recent years, A.B.A. has come under increasingly vehement criticism from members of the neurodiversity movement, who believe that it cruelly pathologizes autistic behavior. They say that its rewards for compliance are dehumanizing; some compare A.B.A. to conversion therapy. Social-media posts condemning the practice often carry the hashtag #ABAIsAbuse. The message that A.B.A. sends is that “your instinctual way of being is incorrect,” Zoe Gross, the director of advocacy at the nonprofit Autistic Self Advocacy Network, told me. “The goals of A.B.A. therapy—from its inception, but still through today—tend to focus on teaching autistic people to behave like non-autistic people.” But others say this criticism obscures the good work that A.B.A. can do. Alicia Allgood, a board-certified behavior analyst who co-runs an A.B.A. agency in New York City, and who is herself autistic, told me, “The autistic community is up in arms. There is a very vocal part of the autistic population that is saying that A.B.A. is harmful or aversive or has potentially caused trauma.”

(cut)

In recent years, private equity has taken a voracious interest in A.B.A. services, partly because they are perceived as inexpensive. Private-equity firms have consolidated many small clinics into larger chains, where providers are often saddled with unrealistic billing quotas and cut-and-paste treatment plans. Last year, the Center for Economic and Policy Research published a startling report on the subject, which included an account of how Blackstone effectively bankrupted a successful A.B.A. provider and shut down more than a hundred of its treatment sites. Private-equity-owned A.B.A. chains have been accused of fraudulent billing and wage theft; message boards for A.B.A. providers overflow with horror stories about low pay, churn, and burnout. High rates of turnover are acutely damaging to a specialty that relies on familiarity between provider and client. “The idea that we could just franchise A.B.A. providers and anyone could do the work—that was misinformed,” Singer, of the Autism Science Foundation, said.

Saturday, March 16, 2024

A New Equilibrium for Telemedicine: Prevalence of In-Person, Video-Based, and Telephone-Based Care in the Veterans Health Administration, 2019–2023

Ferguson, J. M., Wray, C. M., et al. (2024).
Annals of internal medicine, 10.7326/M23-2644.
Advance online publication.
https://doi.org/10.7326/M23-2644




Here is part of a synopsis from The Washington Post.

More than half of mental health appointments — 55 percent — are being conducted remotely, mainly via videoconferencing rather than in-person visits, according to a brief research report in the journal Annals of Internal Medicine.

Telemedicine, also known as telehealth, enables patients to obtain care via technology, most often a cellphone, video chat, computer or tablet.

The study’s findings stem from analysis of patient information from Jan. 1, 2019, through Aug. 31, 2023, from the Department of Veterans Affairs; it included data on more than 277 million outpatient visits made by 9 million veterans.

The research confirmed that the volume of telemedicine visits overall increased dramatically once the coronavirus pandemic began, becoming far more common than in-person visits.

For primary care and mental health care, for instance, the researchers found that in-person appointments dropped from 81 percent to 23 percent in the first few months of the pandemic. By spring 2023, however, phone-based care largely had returned to its pre-pandemic level, but video-based care had stayed close to its pandemic peak, representing a 2,300 percent increase from its pre-pandemic level.


Friday, March 15, 2024

The consciousness wars: can scientists ever agree on how the mind works?

Mariana Lenharo

Neuroscientist Lucia Melloni didn’t expect to be reminded of her parents’ divorce when she attended a meeting about consciousness research in 2018. But, much like her parents, the assembled academics couldn’t agree on anything.

The group of neuroscientists and philosophers had convened at the Allen Institute for Brain Science in Seattle, Washington, to devise a way to empirically test competing theories of consciousness against each other: a process called adversarial collaboration.

Devising a killer experiment was fraught. “Of course, each of them was proposing experiments for which they already knew the expected results,” says Melloni, who led the collaboration and is based at the Max Planck Institute for Empirical Aesthetics in Frankfurt, Germany. Melloni, falling back on her childhood role, became the go-between.

The collaboration Melloni is leading is one of five launched by the Templeton World Charity Foundation, a philanthropic organization based in Nassau, the Bahamas. The charity funds research into topics such as spirituality, polarization and religion; in 2019, it committed US$20 million to the five projects.

The aim of each collaboration is to move consciousness research forward by getting scientists to produce evidence that supports one theory and falsifies the predictions of another. Melloni’s group is testing two prominent ideas: integrated information theory (IIT), which claims that consciousness amounts to the degree of ‘integrated information’ generated by a system such as the human brain; and global neuronal workspace theory (GNWT), which claims that mental content, such as perceptions and thoughts, becomes conscious when the information is broadcast across the brain through a specialized network, or workspace. She and her co-leaders had to mediate between the main theorists, and seldom invited them into the same room.
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Here's what the article highlights:
  • Divisions abound: Researchers disagree on the very definition of consciousness, making comparisons between theories difficult. Some focus on subjective experience, while others look at the brain's functions.
  • Testing head-to-head: New research projects are directly comparing competing theories to see which one explains experimental data better. This could be a step towards finding a unifying explanation.
  • Heated debate: The recent critique of one prominent theory, Integrated Information Theory (IIT), shows the depth of the disagreements. Some question its scientific validity, while others defend it as a viable framework.
  • Hope for progress: Despite the disagreements, there's optimism. New research methods and a younger generation of researchers focused on collaboration could lead to breakthroughs in understanding this elusive phenomenon.

Thursday, March 14, 2024

A way forward for responsibility in the age of AI

Gogoshin, D.L.
Inquiry (2024)

Abstract

Whatever one makes of the relationship between free will and moral responsibility – e.g. whether it’s the case that we can have the latter without the former and, if so, what conditions must be met; whatever one thinks about whether artificially intelligent agents might ever meet such conditions, one still faces the following questions. What is the value of moral responsibility? If we take moral responsibility to be a matter of being a fitting target of moral blame or praise, what are the goods attached to them? The debate concerning ‘machine morality’ is often hinged on whether artificial agents are or could ever be morally responsible, and it is generally taken for granted (following Matthias 2004) that if they cannot, they pose a threat to the moral responsibility system and associated goods. In this paper, I challenge this assumption by asking what the goods of this system, if any, are, and what happens to them in the face of artificially intelligent agents. I will argue that they neither introduce new problems for the moral responsibility system nor do they threaten what we really (ought to) care about. I conclude the paper with a proposal for how to secure this objective.


Here is my summary:

While AI may not possess true moral agency, it's crucial to consider how the development and use of AI can be made more responsible. The author challenges the assumption that AI's lack of moral responsibility inherently creates problems for our current system of ethics. Instead, they focus on the "goods" this system provides, such as deserving blame or praise, and how these can be upheld even with AI's presence. To achieve this, the author proposes several steps, including:
  1. Shifting the focus from AI's moral agency to the agency of those who design, build, and use it. This means holding these individuals accountable for the societal impacts of AI.
  2. Developing clear ethical guidelines for AI development and use. These guidelines should be comprehensive, addressing issues like fairness, transparency, and accountability.
  3. Creating robust oversight mechanisms. This could involve independent bodies that monitor AI development and use, and have the power to intervene when necessary.
  4. Promoting public understanding of AI. This will help people make informed decisions about how AI is used in their lives and hold developers and users accountable.

Wednesday, March 13, 2024

None of these people exist, but you can buy their books on Amazon anyway

Conspirador Norteno
Substack.com
Originally published 12 Jan 24

Meet Jason N. Martin N. Martin, the author of the exciting and dynamic Amazon bestseller “How to Talk to Anyone: Master Small Talks, Elevate Your Social Skills, Build Genuine Connections (Make Real Friends; Boost Confidence & Charisma)”, which is the 857,233rd most popular book on the Kindle Store as of January 12th, 2024. There are, however, a few obvious problems. In addition to the unnecessary repetition of the middle initial and last name, Mr. N. Martin N. Martin’s official portrait is a GAN-generated face, and (as we’ll see shortly), his sole published work is strangely similar to several books by another Amazon author with a GAN-generated face.

In an interesting twist, Amazon’s recommendation system suggests another author with a GAN-generated face in the “Customers also bought items by” section of Jason N. Martin N. Martin’s author page. Further exploration of the recommendations attached to both of these authors and their published works reveals a set of a dozen Amazon authors with GAN-generated faces and at least one published book. Amazon’s recommendation algorithms reliably link these authors together; whether this is a sign that the twelve author accounts are actually run by the same entity or merely an artifact of similarities in the content of their books is unclear at this point in time. 


Here's my take:

Forget literary pen names - AI is creating a new trend on Amazon: ghostwritten books. These novels, poetry collections, and even children's stories boast intriguing titles and blurbs, yet none of the authors on the cover are real people. Instead, their creations spring from the algorithms of powerful language models.

Here's the gist:
  • AI churns out content: Fueled by vast datasets of text and code, AI can generate chapters, characters, and storylines at an astonishing pace.
  • Ethical concerns: Questions swirl around copyright, originality, and the very nature of authorship. Is an AI-generated book truly a book, or just a clever algorithm mimicking creativity?
  • Quality varies: While some AI-written books garner praise, others are criticized for factual errors, nonsensical plots, and robotic dialogue.
  • Transparency is key: Many readers feel deceived by the lack of transparency about AI authorship. Should books disclose their digital ghostwriters?
This evolving technology challenges our understanding of literature and raises questions about the future of authorship. While AI holds potential to assist and inspire, the human touch in storytelling remains irreplaceable. So, the next time you browse Amazon, remember: the author on the cover might not be who they seem.

Tuesday, March 12, 2024

Discerning Saints: Moralization of Intrinsic Motivation and Selective Prosociality at Work

Kwon, M., Cunningham, J. L., & 
Jachimowicz, J. M. (2023).
Academy of Management Journal, 66(6),
1625–1650.

Abstract

Intrinsic motivation has received widespread attention as a predictor of positive work outcomes, including employees’ prosocial behavior. We offer a more nuanced view by proposing that intrinsic motivation does not uniformly increase prosocial behavior toward all others. Specifically, we argue that employees with higher intrinsic motivation are more likely to value intrinsic motivation and associate it with having higher morality (i.e., they moralize it). When employees moralize intrinsic motivation, they perceive others with higher intrinsic motivation as being more moral and thus engage in more prosocial behavior toward those others, and judge others who are less intrinsically motivated as less moral and thereby engage in less prosocial behaviors toward them. We provide empirical support for our theoretical model across a large-scale, team-level field study in a Latin American financial institution (n = 784, k = 185) and a set of three online studies, including a preregistered experiment (n = 245, 243, and 1,245), where we develop a measure of the moralization of intrinsic motivation and provide both causal and mediating evidence. This research complicates our understanding of intrinsic motivation by revealing how its moralization may at times dim the positive light of intrinsic motivation itself.

The article is paywalled.  Here are some thoughts:

This study focuses on how intrinsically motivated employees (those who enjoy their work) might act differently towards other employees depending on their own level of intrinsic motivation. The key points are:

Main finding: Employees with high intrinsic motivation tend to associate higher morality with others who also have high intrinsic motivation. This leads them to offer more help and support to those similar colleagues, while judging and helping less to those with lower intrinsic motivation.

Theoretical framework: The concept of "moralization of intrinsic motivation" (MOIM) explains this behavior. Essentially, intrinsic motivation becomes linked to moral judgment, influencing who is seen as "good" and deserving of help.

Implications:
  • For theory: This research adds a new dimension to understanding intrinsic motivation, highlighting the potential for judgment and selective behavior.
  • For practice: Managers and leaders should be aware of the unintended consequences of promoting intrinsic motivation, as it might create bias and division among employees.
  • For employees: Those lacking intrinsic motivation might face disadvantages due to judgment from colleagues. They could try job crafting or seeking alternative support strategies.
Overall, the study reveals a nuanced perspective on intrinsic motivation, acknowledging its positive aspects while recognizing its potential to create inequality and ethical concerns.

Monday, March 11, 2024

Why People Fail to Notice Horrors Around Them

Tali Sharot and Cass R. Sunstein
The New York Times
Originally posted 25 Feb 24

The miraculous history of our species is peppered with dark stories of oppression, tyranny, bloody wars, savagery, murder and genocide. When looking back, we are often baffled and ask: Why weren't the horrors halted earlier? How could people have lived with them?

The full picture is immensely complicated. But a significant part of it points to the rules that govern the operations of the human brain.

Extreme political movements, as well as deadly conflicts, often escalate slowly. When threats start small and increase gradually, they end up eliciting a weaker emotional reaction, less resistance and more acceptance than they would otherwise. The slow increase allows larger and larger horrors to play out in broad daylight- taken for granted, seen as ordinary.

One of us is a neuroscientist; the other is a law professor. From our different fields, we have come to believe that it is not possible to understand the current period - and the shifts in what counts as normal - without appreciating why and how people do not notice so much of what we live with.

The underlying reason is a pivotal biological feature of our brain: habituation, or our tendency to respond less and less to things that are constant or that change slowly. You enter a cafe filled with the smell of coffee and at first the smell is overwhelming, but no more than 20 minutes go by and you cannot smell it any longer. This is because your olfactory neurons stop firing in response to a now-familiar odor.

Similarly, you stop hearing the persistent buzz of an air-conditioner because your brain filters out background noise. Your brain cares about what recently changed, not about what remained the same.
Habituation is one of our most basic biological characteristics - something that we two-legged, bigheaded creatures share with other animals on earth, including apes, elephants, dogs, birds, frogs, fish and rats. Human beings also habituate to complex social circumstances such as war, corruption, discrimination, oppression, widespread misinformation and extremism. Habituation does not only result in a reduced tendency to notice and react to grossly immoral deeds around us; it also increases the likelihood that we will engage in them ourselves.


Here is my summary:

From a psychological perspective, the failure to notice horrors around us can be attributed to cognitive biases and the human tendency to see reality in predictable yet flawed ways. This phenomenon is linked to how individuals perceive and value certain aspects of their environment. Personal values play a crucial role in shaping our perceptions and emotional responses. When there is a discrepancy between our self-perception and reality, it can lead to various troubles as our values define us and influence how we react to events. Additionally, the concept of safety needs is highlighted as a mediating factor in mental disorders induced by stressful events. The unexpected nature of events can trigger fear and anger, while the anticipation of events can induce calmness. This interplay between safety needs, emotions, and pathological conditions underscores how individuals react to perceived threats and unexpected situations, impacting their mental well-being

Sunday, March 10, 2024

MAGA’s Violent Threats Are Warping Life in America

David French
New York Times - Opinion
Originally published 18 Feb 24

Amid the constant drumbeat of sensational news stories — the scandals, the legal rulings, the wild political gambits — it’s sometimes easy to overlook the deeper trends that are shaping American life. For example, are you aware how much the constant threat of violence, principally from MAGA sources, is now warping American politics? If you wonder why so few people in red America seem to stand up directly against the MAGA movement, are you aware of the price they might pay if they did?

Late last month, I listened to a fascinating NPR interview with the journalists Michael Isikoff and Daniel Klaidman regarding their new book, “Find Me the Votes,” about Donald Trump’s efforts to overturn the 2020 election. They report that Georgia prosecutor Fani Willis had trouble finding lawyers willing to help prosecute her case against Trump. Even a former Georgia governor turned her down, saying, “Hypothetically speaking, do you want to have a bodyguard follow you around for the rest of your life?”

He wasn’t exaggerating. Willis received an assassination threat so specific that one evening she had to leave her office incognito while a body double wearing a bulletproof vest courageously pretended to be her and offered a target for any possible incoming fire.


Here is my summary of the article:

David French discusses the pervasive threat of violence, particularly from MAGA sources, and its impact on American politics. The author highlights instances where individuals faced intimidation and threats for opposing the MAGA movement, such as a Georgia prosecutor receiving an assassination threat and judges being swatted. The article also mentions the significant increase in threats against members of Congress since Trump took office, with Capitol Police opening over 8,000 threat assessments in a year. The piece sheds light on the chilling effect these threats have on individuals like Mitt Romney, who spends $5,000 per day on security, and lawmakers who fear for their families' safety. The overall narrative underscores how these violent threats are shaping American life and politics