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

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

Saturday, September 22, 2018

The Business Case for Curiosity

Francesca Gino
Harvard Business Review
Originally posted September-October Issue

Here are two excerpts:

The Benefits of Curiosity

New research reveals a wide range of benefits for organizations, leaders, and employees.

Fewer decision-making errors.

In my research I found that when our curiosity is triggered, we are less likely to fall prey to confirmation bias (looking for information that supports our beliefs rather than for evidence suggesting we are wrong) and to stereotyping people (making broad judgments, such as that women or minorities don’t make good leaders). Curiosity has these positive effects because it leads us to generate alternatives.

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It’s natural to concentrate on results, especially in the face of tough challenges. But focusing on learning is generally more beneficial to us and our organizations, as some landmark studies show. For example, when U.S. Air Force personnel were given a demanding goal for the number of planes to be landed in a set time frame, their performance decreased. Similarly, in a study led by Southern Methodist University’s Don VandeWalle, sales professionals who were naturally focused on performance goals, such as meeting their targets and being seen by colleagues as good at their jobs, did worse during a promotion of a product (a piece of medical equipment priced at about $5,400) than reps who were naturally focused on learning goals, such as exploring how to be a better salesperson. That cost them, because the company awarded a bonus of $300 for each unit sold.

A body of research demonstrates that framing work around learning goals (developing competence, acquiring skills, mastering new situations, and so on) rather than performance goals (hitting targets, proving our competence, impressing others) boosts motivation. And when motivated by learning goals, we acquire more-diverse skills, do better at work, get higher grades in college, do better on problem-solving tasks, and receive higher ratings after training. Unfortunately, organizations often prioritize performance goals.

The information is here.

Friday, September 21, 2018

Surprised By A Medical Bill? Join The Club. Most Americans Say They Have Been

Alison Kodjak
www.npr.org
Originally posted September 2, 2018

Here is an excerpt:

Most survey respondents — 57 percent — have been surprised by a medical bill they thought would be paid for by their insurance companies, the survey from the research group NORC at the University of Chicago finds.

"People get surprised by all kinds of bills, for all kinds of reasons," says Caroline Pearson, a senior fellow at NORC.

Pearson herself says she was not expecting the problem to be so widespread.

The survey shows that 53 percent of those surveyed were surprised by a bill for a physician's service, and 51 percent got an unexpected bill for a laboratory test – like the urine test featured in our earlier story.

Hospital and health care facility charges surprised 43 percent of respondents, and 35 percent reported getting unexpected bills for imaging services, like the CT scan featured by NPR.

The survey shows that while some of the unexpected bills come because doctors or hospitals where patients are treated don't participate in the patients' insurance networks, the majority come because patients expect their insurance to cover more than it actually does.

The info is here.

Why Social Science Needs Evolutionary Theory

Christine Legare
Nautilus.com
Originally posted June 15, 2018

Here is an excerpt:

Human cognition and behavior is the product of the interaction of genetic and cultural evolution. Gene-culture co-evolution has allowed us to adapt to highly diverse ecologies and to produce cultural adaptations and innovations. It has also produced extraordinary cultural diversity. In fact, cultural variability is one of our species’ most distinctive features. Humans display a wider repertoire of behaviors that vary more within and across groups than any other animal. Social learning enables cultural transmission, so the psychological mechanisms supporting it should be universal. These psychological mechanisms must also be highly responsive to diverse developmental contexts and cultural ecologies.

Take the conformity bias. It is a universal proclivity of all human psychology—even very young children imitate the behavior of others and conform to group norms. Yet beliefs about conformity vary substantially between populations. Adults in some populations are more likely to associate conformity with children’s intelligence, whereas others view creative non-conformity as linked with intelligence. Psychological adaptations for social learning, such as conformity bias, develop in complex and diverse cultural ecologies that work in tandem to shape the human mind and generate cultural variation.

The info is here.

Thursday, September 20, 2018

Man-made human 'minibrains' spark debate on ethics and morality

Carolyn Y. Johnson
www.iol.za
Originally posted September 3, 2018

Here is an excerpt:

Five years ago, an ethical debate about organoids seemed to many scientists to be premature. The organoids were exciting because they were similar to the developing brain, and yet they were incredibly rudimentary. They were constrained in how big they could get before cells in the core started dying, because they weren't suffused with blood vessels or supplied with nutrients and oxygen by a beating heart. They lacked key cell types.

Still, there was something different about brain organoids compared with routine biomedical research. Song recalled that one of the amazing but also unsettling things about the early organoids was that they weren't as targeted to develop into specific regions of the brain, so it was possible to accidentally get retinal cells.

"It's difficult to see the eye in a dish," Song said.

Now, researchers are succeeding at keeping organoids alive for longer periods of time. At a talk, Hyun recalled one researcher joking that the lab had sung "Happy Birthday" to an organoid when it was a year old. Some researchers are implanting organoids into rodent brains, where they can stay alive longer and grow more mature. Others are building multiple organoids representing different parts of the brain, such as the hippocampus, which is involved in memory, or the cerebral cortex - the seat of cognition - and fusing them together into larger "assembloids."

Even as scientists express scepticism that brain organoids will ever come close to sentience, they're the ones calling for a broad discussion, and perhaps more oversight. The questions range from the practical to the fantastical. Should researchers make sure that people who donate their cells for organoid research are informed that they could be used to make a tiny replica of parts of their brain? If organoids became sophisticated enough, should they be granted greater protections, like the rules that govern animal research? Without a consensus on what consciousness or pain would even look like in the brain, how will scientists know when they're nearing the limit?

The info is here.

John Rawls’ ‘A Theory of Justice’

Ben Davis
1000-Word Philosophy
Originally posted July 27, 2018

Here is an excerpt:

Reasonable people often disagree about how to live, but we need to structure society in a way that reasonable members of that society can accept. Citizens could try to collectively agree on basic rules. We needn’t decide every detail: we might only worry about rules concerning major political and social institutions, like the legal system and economy, which form the ‘basic structure’ of society.

A collective agreement on the basic structure of society is an attractive ideal. But some people are more powerful than others: some may be wealthier, or part of a social majority. If people can dominate negotiations because of qualities that are, as Rawls (72-75) puts it, morally arbitrary, that is wrong. People don’t earn these advantages: they get them by luck. For anyone to use these unearned advantages to their own benefit is unfair, and the source of many injustices.

This inspires Rawls’ central claim that we should conceive of justice ‘as fairness.’ To identify fairness, Rawls (120) develops two important concepts: the original position and the veil of ignorance:

The original position is a hypothetical situation: Rawls asks what social rules and institutions people would agree to, not in an actual discussion, but under fair conditions, where nobody knows whether they are advantaged by luck. Fairness is achieved through the veil of ignorance, an imagined device where the people choosing the basic structure of society (‘deliberators’) have morally arbitrary features hidden from them: since they have no knowledge of these features, any decision they make can’t be biased in their own favour.

The brief, excellent synopsis is here.

Wednesday, September 19, 2018

Why “happy” doctors die by suicide

Pamela Wible
www.idealmedicalcare.org
Originally posted on August 24, 2018

Here is an excerpt:

Doctor suicides on the registry were submitted to me during a six-year period (2012-2018) by families, friends, and colleagues who knew the deceased. After speaking to thousands of suicidal physicians since 2012 on my informal doctor suicide hotline and analyzing registry data, I discovered surprising themes—many unique to physicians.

Public perception maintains that doctors are successful, intelligent, wealthy, and immune from the problems of the masses. To patients, it is inconceivable that doctors would have the highest suicide rate of any profession (5).

Even more baffling, “happy” doctors are dying by suicide. Many doctors who kill themselves appear to be the most optimistic, upbeat, and confident people. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head.

Doctors are masters of disguise and compartmentalization.

Turns out some of the happiest people—especially those who spend their days making other people happy—may be masking their own despair.

The info is here.

Many Cultures, One Psychology?

Nicolas Geeraert
American Scientist
Originally published in the July-August issue

Here is an excerpt:

The Self

If you were asked to describe yourself, what would you say? Would you list your personal characteristics, such as being intelligent or funny, or would you use preferences, such as “I love pizza”? Or perhaps you would instead mention social relationships, such as “I am a parent”? Social psychologists have long maintained that people are much more likely to describe themselves and others in terms of stable personal characteristics than they are to describe themselves in terms of their preferences or relationships.

However, the way people describe themselves seems to be culturally bound. In a landmark 1991 paper, social psychologists Hazel R. Markus and Shinobu Kitayama put forward the idea that self-construal is culturally variant, noting that individuals in some cultures understand the self as independent, whereas those in other cultures perceive it as interdependent.

People with an independent self-construal view themselves as free, autonomous, and unique individuals, possessing stable boundaries and a set of fixed characteristics or attributes by which their actions are guided. Independent self-construal is more prevalent in Europe and North America. By contrast, people with an interdependent self-construal see themselves as more connected with others close to them, such as their family or community, and think of themselves as a part of different social relationships.

The information is here.

Tuesday, September 18, 2018

Changing the way we communicate about patients

Abraar Karan
BMJ Blog
Originally posted August 29, 2018

Here is an excerpt:

There are many changes that we can make to improve how we communicate about patients. One of the easiest and most critical transformations is how we write our medical notes. One of the best doctors I ever worked with did exactly this, and is famous at the Brigham (our hospital) for doing it. He systematically starts every single note with the person’s social history. Who is this patient? It is not just a lady with abdominal pain. It is a mother of three, a retired teacher, and an active cyclist. That is the first thing we read about her, and so when I enter her room, I can’t help but see her this way rather than as a case of appendicitis.

This matters because patients deserve to be treated as people—a statement that’s so obvious it shouldn’t need to be said, but which physician behaviour doesn’t always reflect. You wouldn’t expect to know the most sensitive and vulnerable aspects of someone before even knowing their most basic background, yet we do this in medicine all the time. This is also important because in many clinical presentations, it provides critical information that helps deduce how they got sick, and why they may get sick again in the same way if we don’t restructure something essential in their life. For instance, if I didn’t know that the 22 year old opioid addict had just been kicked out of his house and is on the street without transportation to get to his suboxone clinic, I will not have truly solved what brought him to the hospital in the first place.

The info is here.

The So-Called Right to Try Law Gives Patients False Hope

Claudia Wallis
Scientific American
Originally posted in the September 2018 issue

There's no question about it: the new law sounds just great. President Donald Trump, who knows a thing or two about marketing, gushed about its name when he signed the “Right to Try” bill into law on May 30. He was surrounded by patients with incurable diseases, including a second grader with Duchenne muscular dystrophy, who got up from his small wheelchair to hug the president. The law aims to give such patients easier access to experimental drugs by bypassing the Food and Drug Administration.

The crowd-pleasing name and concept are why 40 states had already passed similar laws, although they were largely symbolic until the federal government got onboard. The laws vary but generally say that dying patients may seek from drugmakers any medicine that has passed a phase I trial—a minimal test of safety. “We're going to be saving tremendous numbers of lives,” Trump said. “The current FDA approval process can take many, many years. For countless patients, time is not what they have.”

But the new law won't do what the president claims. Instead it gives false hope to the most vulnerable patients. “This is a right to ask, not a right to try,” says Alison Bateman-House, a medical ethicist at New York University and an expert on the compassionate use of experimental drugs.

The info is here.