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

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

Wednesday, October 31, 2012

Army Releases September Suicide Data

IMMEDIATE RELEASE No. 838-12

October 19, 2012

The Army released suicide data today for the month of September. During September, among active-duty soldiers, there were 15 potential suicides: one has been confirmed as suicide and 14 remain under investigation. For August, the Army reported 16 potential suicides among active-duty soldiers. Since the release of that report, one case was removed for a total of 15 cases: five have been confirmed as suicides and 10 remain under investigation. For 2012, there have been 146 potential active-duty suicides: 91 have been confirmed as suicides and 55 remain under investigation. Active-duty suicide number for 2011: 165 confirmed as suicides and no cases under investigation.

During September, among reserve component soldiers who were not on active duty, there were 16 potential suicides (13 Army National Guard and three Army Reserve): one has been confirmed as suicide and 15 remain under investigation. For August, among that same group, the Army reported nine potential suicides. Since the release of that report two cases were added for a total of 11 cases (seven Army National Guard and four Army Reserve): five have been confirmed as suicides and six remain under investigation.

For 2012, there have been 101 potential not on active-duty suicides (67 Army National Guard and 34 Army Reserve): 67 have been confirmed as suicides and 34 remain under investigation. Not on active-duty suicide numbers for 2011: 118 (82 Army National Guard and 36 Army Reserve) confirmed as suicides and no cases under investigation.

"Every suicide in our ranks is a tragic loss for the Army family, adversely affecting the readiness of our Army," said Lt. Gen. Howard B. Bromberg, deputy chief of staff for manpower and personnel. "I am asking soldiers, family members, department of the Army civilians, neighbors, and friends to look out for each other and reach out and embrace those who may be struggling. Recognize the warning signs such as substance abuse, relationship problems, and withdrawal from friends and activities and use available resources to help yourself or others. Our actions can save lives."

Soldiers and families in need of crisis assistance can contact the National Suicide Prevention Lifeline. Trained consultants are available 24 hours a day, seven days a week, 365 days a year and can be contacted by dialing 1-800-273-TALK (8255) or by visiting their website at http://www.suicidepreventionlifeline.org

Tuesday, October 30, 2012

Va. health commissioner quits, citing abortion regulations

By Olympia Meola
Richmond Times-Dispatch
Originally published October 19, 2012

Virginia's health commissioner, Dr. Karen Remley, resigned Thursday, saying the environment in the wake of new abortion clinic regulations compromised her ability to fulfill her duties.

Remley steered the massive state health agency during two gubernatorial administrations and recently as the Virginia Board of Health dealt with controversial abortion clinic regulations.

"Unfortunately, how specific sections of the Virginia Code pertaining to the development and enforcement of these regulations have been, and continue to be, interpreted has created an environment in which my ability to fulfill my duties is compromised, and in good faith I can no longer serve in my role," she wrote in a letter to Gov. Bob McDonnell.

Remley's resignation, effective Thursday, is the latest twist in a long and highly charged process surrounding the state's abortion clinic regulations.

The Board of Health voted Sept. 14 to adopt regulations that require existing abortion clinics in Virginia to be regulated like new hospitals.

The regulations, hailed by anti-abortion advocates, were approved over the angry objections of abortion-rights advocates, who said the new rules were a thinly veiled attempt to curtail access to abortion services by imposing construction costs on clinics that would force many to close.

The entire story is here.

Monday, October 29, 2012

Augusta man arrested on child pornography charges


Written by Krister Rollins
WCSH 6 News
Originally published October 3, 2012


A man from Augusta who worked at the National Alliance on Mental Illness and ran a martial arts studio has been arrested, charged with distributing child pornography.

Wade Hoover was arrested at the Augusta offices of the National Alliance on Mental Illness (NAMI) Wednesday morning.

According to a media release from State Police Spokesperson Steve McCausland, officers from the State Police Computer Crimes Unit and the federal Immigration and Customs Enforcement Agency were operating on a tip when they went to his office.

The entire story is here.

D'Souza Resigns From King's College

Inside Higher Ed
Originally published October 19, 2012

Dinesh D'Souza, president of the King's College, a Christian college in New York City, has resigned after reports that he shared a hotel room with a woman to whom he was not married before filing for divorce from his wife. In a statement posted on the college's website Thursday, the president of the Board of Trustees said that D'Souza had resigned, effective immediately, to "allow him to attend to his personal and family needs."

The entire story is here.

Sunday, October 28, 2012

U.S. Set to Sponsor Health Insurance

By Robert Pear
The New York Times
Originally published October 27, 2012

The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide.

The entire story is here.

Preventing Childhood And Adolescent Suicide

Medical News Today
Originally published October 12, 2012

Here are some exerpts:

At the beginning of the 21st century, suicide and suicide attempts by children and adolescents continue to be a major public health problem, and topical research and surveys have clearly highlighted suicide as one of the commonest causes of death among young people.

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Suicide is one of the major causes of death worldwide and suicide rates vary according to region, sex, age, time, ethnic origin, and, probably, practices of death registration. Most people who die by suicide have psychiatric disorders, notably mood, substance-related, anxiety, psychotic, and personality disorders, with high rates of comorbidity.

Suicidal cognitions and behaviours can occur both independently and together. Risk of onset of suicidal ideation increases rapidly during adolescence and young adulthood, and then stabilizes in early midlife. The prevalence rates in adolescents cross-nationally are reported to be 19.8.0% for suicide ideation, and 3.1%.8% for suicide attempts (Nock et al, 2008a).

The entire story is here.

Saturday, October 27, 2012

New psychiatric drugs low priority for pharmaceutical firms

CBC News
Originally posted October 12, 2012

The pharmaceutical industry has largely abandoned drug development for mental illnesses even though depression is a leading cause of disability, experts say.

Authors of papers published in this week's issue of the journal Science Translational Medicine argue that drug discovery for treating psychiatric disorders such as autism, schizophrenia, bipolar disorder and depression are at a near standstill.

"Antipsychotics and antidepressants have been some of the most profitable agents for companies over the last two decades," said Dr. Thomas Insel, director of the U.S. National Institute of Mental Health and one of the authors.

"But that doesn't mean they're effective. What it means is that they sell and they can be marketed."

In the last five decades, more than 20 antipsychotics and 30 antidepressants have been marketed with over $25 billion in sales in the U.S. in 2011 alone, Insel said.

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"The central problem is clear: Neither vast unmet medical need, nor large and growing markets, nor concerted sales campaigns that attempt to recast 'me-too drugs' as innovative can illuminate a path across very difficult scientific terrain," Hyman wrote.

The entire story is here.

Friday, October 26, 2012

Boy Scout Files Give Glimpse Into 20 Years of Sex Abuse

By Kirk Johnson
The New York Times
Originally published October 18, 2012

Details of decades of sexual abuse in the Boy Scouts of America, and what child welfare experts say was a corrosive culture of secrecy that compounded the damage, were cast into full public view for the first time on Thursday with the release of thousands of pages of documents describing abuse accusations across the country.

“The secrets are out,” said Kelly Clark, a lawyer whose firm obtained the files as evidence in an $18.5 million civil judgment against the Scouts in 2010. The legal effort to make the files public, by a group of national and local media outlets, including The New York Times — and represented by another lawyer, Charles F. Hinkle — resulted in an Oregon Supreme Court decision in June ordering full release. Mr. Clark said in a news conference that the database would be sortable by state, year and name.
      
Officials with the Boy Scouts fought in the courts for years to prevent the release of the documents — more than 15,000 pages detailing accusations of sexual abuse against 1,247 scout leaders between 1965 and 1985, with thousands of victims involved, perhaps many thousands — contending that fear of breached confidentiality could inhibit victims from reporting other instances of abuse.
 

Thursday, October 25, 2012

7 More Cancer Scientists Quit Texas Institute Over Grants

By The Associated Press
Originally published on October 13, 2012

At least seven more scientists have resigned in protest from Texas’ embattled $3 billion cancer-fighting program, claiming that the agency in charge of it is charting a “politically driven” path that puts commercial interests before science.

The Cancer Prevention and Research Institute of Texas, created with the backing of Gov. Rick Perry and the cyclist Lance Armstrong, a cancer survivor, has awarded nearly $700 million in grants since 2009; only the National Institutes of Health offers a bigger pot of cancer-research money.

Wednesday, October 24, 2012

A Schizophrenic on Death Row

The Opinion Pages
The New York Times
Originally published Ocotber 17, 2012

The Florida Supreme Court decided on Wednesday that the state can proceed with the execution next week of a 64-year-old inmate named John Ferguson. His lawyers immediately said that they will ask the United States Supreme Court to stay the execution and to review the case on grounds that Mr. Ferguson is mentally incompetent and that executing him would violate his constitutional rights as defined by the court in two earlier decisions.

The court must review the case. At issue are not only Mr. Ferguson’s life but also two differing interpretations of what constitutes competence: one Florida’s, the other the Supreme Court’s.

The entire story is here.

Tuesday, October 23, 2012

American Therapeutics' program director Abreu gets 108 months

 by Kevin Gale
South Florida Business Journal
Originally published October 15, 2012


Vanja Abreu, former program director at the mental health care company American Therapeutic Corporation (ATC), was sentenced Thursday to 108 months in prison for participating in the $205 million Medicare fraud scheme, a press release from the U.S. Attorney's office said.

Abreu, 49, of Pembroke Pines, worked at ATC centers in Boca Raton and Miami. In addition to her prison term, U.S. District Judge Patricia A. Seitz sentenced Abreu to three years of supervised release following her prison term and ordered her to pay $72.7 million in restitution, jointly and severally with co-defendants.

On June 1, after a seven-week trial, a federal jury in the Southern District of Florida found Abreu, who holds a doctorate degree, guilty of one count of conspiracy to commit health care fraud.

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Evidence at trial revealed that program directors, including Abreu, helped doctors at ATC sign patient files without reading the files or seeing the patients. Evidence further revealed that Abreu and others would assist the owners of ATC in fabricating doctor notes, therapist notes and other documents to make it falsely appear in ATC’s patient files that patients were qualified for this highly specialized treatment and that the patients were receiving the intensive, individualized treatment PHP is supposed to be.

The entire story is here.




Monday, October 22, 2012

Self-Reflection in Ethical Choice Making

Balancing Values Through the Looking Glass
By Allison Bashe
The Ethical Professor Blog
Originally published October 21, 2012

Self-reflection may be the most critical ingredient to making good ethical choices.  As professors, we need to highlight the importance of self-reflection in our undergraduate and graduate ethics courses.  We can do this through assignments that encourage self-reflection and emphasize to students the importance of self-reflection throughout their professional careers.  More importantly, we can highlight the importance of self-reflection by engaging in it on a regular basis and modeling this practice to our students.

At the 17th Annual Ethics Educators Conference in Harrisburg, PA, professionals reflected on their core values and then discussed how these values might be compatible with or might conflict with the profession of psychology.  Although generally the professionals in the room could appreciate the value of self-reflection, one person acknowledged that he initially felt oppositional toward an exercise that required him to consider how his values might conflict with our profession.  He commented that if our values conflict with our profession, it might indicate that we have not worked hard enough yet.  And that’s exactly the point:  Self-reflection helps us sharpen our focus to make better decisions.

The entire blog post is here.

The video can be found here.


Pa. Supreme Court rules general practitioners not held to sex prohibitions

Prohibitions stands for mental health care providers

By Zack Needles
The Legal Intelligencer
Originally published October 15, 2012

In a case of first impression, the state Supreme Court has ruled that general practitioner doctors are not barred from having consensual sex with a patient, even if they are also providing "incidental mental health treatment" to the patient.
In so doing, the court has refused to extend the prohibition that prevents mental health physicians from having consensual sex with their patients -- and makes those who do susceptible to medical malpractice suit -- to general practitioners and family doctors.

In Thierfelder v. Wolfert, the high court ruled 5-1 -- suspended Justice Joan Orie Melvin did not participate in the decision -- to reverse a divided May 2009 Superior Court ruling that both general practitioners and psychiatrists "need to maintain the same trust when rendering psychological care."

Chief Justice Ronald D. Castille, writing for the majority, said that even what might constitute an ethical violation does not necessarily amount to a legal violation.

"The question is not whether this court condones appellant's actions, nor even whether his actions amounted to a violation of medical ethics," Justice Castille said. "We hold here only that, as a general practitioner, appellant was under no specific or 'heightened' duty in tort to refrain from sexual relations with his patient under these circumstances."

Sunday, October 21, 2012

Guilt Proneness and Moral Character


By Taya R. Cohen, A. T. Panter and Nazli Turan
Current Directions in Psychological Science 
October 2012 21: 355-359

Abstract

Guilt proneness is a personality trait indicative of a predisposition to experience negative feelings about personal wrongdoing, even when the wrongdoing is private. It is characterized by the anticipation of feeling bad about committing transgressions rather than by guilty feelings in a particular moment or generalized guilty feelings that occur without an eliciting event. Our research has revealed that guilt proneness is an important character trait because knowing a person’s level of guilt proneness helps us to predict the likelihood that person will behave unethically. Web-based studies of adults across the United States have shown that people who score high on measures of guilt proneness (compared to low scorers) make fewer unethical business decisions, commit fewer delinquent behaviors, and behave more honestly when making economic decisions. In the workplace, guilt-prone employees are less likely to engage in counterproductive behaviors that harm their organization.

The entire article is here.

A review of the research article is here.

Saturday, October 20, 2012

Sports in the Board Room

By Allie Grasgreen
Inside Higher Ed
Originally published October 10, 2012


The very morning that the man whose actions brought down top administrators at Pennsylvania State University was being condemned to at least 30 years in prison for child abuse, critics of big-time collegiate athletics gathered here were discussing the role -- or lack thereof -- of university governing boards in sports programs.

In documenting the many failings revealed by the abuse scandal at Penn State, the report by Louis J. Freeh documented the faults of the university's former president, Graham Spanier -- among them, neglecting to adequately alert the 32-member Board of Trustees about red flags regarding former assistant football coach Jerry Sandusky.

But equally or even more so at fault, the report said, was the board itself, whose trustees failed to ask questions of Spanier or themselves, such as whether they should conduct an internal investigation. They lacked the necessary structures even to make sure they got the information they needed to properly assess and address potential risks, the report said.

And so officials from the Association of Governing Boards of Universities and Colleges recognized the “crisis” at Penn State and role the board played in it, as they presented the findings of a new survey and report on board responsibilities for intercollegiate athletics here Wednesday at a meeting of the Knight Commission on Intercollegiate Athletics.

The entire story is here.

Friday, October 19, 2012

To Encrypt Email or Not to Encrypt Email? Practical Answers to a Question That Is Surprisingly Complex

by Elizabeth H. Johnson
Poyner Spruill LLP
Originally posted on October 5, 2012


Health care providers frequently ask us whether they have to encrypt emails, particularly those sent to patients who have asked for an emailed copy of their health records. Since patients have a right to receive electronic copies of their health records, emailing them a copy when they ask for it seems like the right thing to do.

Unfortunately, the decision actually is more complicated. HIPAA requires that all electronic transmissions of protected health information (PHI) be encrypted. That means ALL of them … fax, email, web-based and otherwise. The requirement applies regardless of the identity of the recipient or patient, and the recipient cannot “undo” or waive the requirement by consenting to the receipt of unencrypted emails.

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One more time in English? Health care providers are allowed to send PHI in unencrypted emails but only after they engage in the analysis described above and document their determination. It is a violation of the HIPAA Security Rule to send unencrypted emails containing PHI without first having performed and documented that analysis. A single violation can carry a penalty as high as $50,000, a useful figure to contemplate if you think encryption is too expensive to implement. Encryption also carries the benefit of qualifying for a “safe harbor” under HIPAA’s breach notification requirements. A security incident that would otherwise require notification is not considered a breach if the PHI affected were encrypted and the encryption key has not been compromised.

The entire article is here.

Thanks to Marlene Maheu for this article via LinkedIn.

Thursday, October 18, 2012

Phone Therapy Is Effective, Increases Access And Potentially Decreases Costs

Medical News Today
Originally published October 2, 2012


A new study reveals that cognitive therapy over the phone is just as effective as meeting face-to-face. The research was published in the journal PLoS ONE.

Researchers at the University of Cambridge together with the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care (NIHR CLAHRC) and NHS Midlands & East also found that providing talking therapy over the phone increases access to psychological therapies for people with common mental disorders and potentially saves the NHS money.

For the study, data from 39,000 patients in seven established Improving Access to Psychological Therapies (IAPT) services (an initiative which aims to expand the availability of psychological therapies) in the East of England were used to compare Cognitive Behavioural Therapy (CBT) delivered face-to-face versus over the phone. For all but an infrequent, identifiable clinical group with more severe illness, therapy over the phone was as effective as face to face, and the cost per session was 36.2% lower.


Wednesday, October 17, 2012

Attention Disorder or Not, Pills to Help in School

By ALAN SCHWARZ
The New York Times
Originally published October 9, 2012

Here is an excerpt:

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”

Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.

After Decades in Institutions, a Bumpy Journey to a New Life


By RACHEL L. SWARNS
The New York Times
Originally published September 29, 2012

Here are some excerpts:

Once viewed as outcasts to be shunned and isolated in institutions, hundreds of Georgia’s most disabled citizens are taking their first tentative steps back into society. Their fledgling journeys, marked by uncertainty, jubilation and some setbacks, are unfolding as officials embark on an ambitious plan to profoundly reshape the lives of the cognitively and physically impaired.

It is a new strategy for Georgia, one of several states responding to mounting pressure from the Justice Department, which in recent years has threatened legal action against states accused of violating the civil rights of thousands of developmentally disabled people by needlessly segregating them in public hospitals, nursing homes and day programs.

Mississippi, which has nearly 2,000 developmentally disabled people living in its institutions, began moving dozens of them out this spring. Virginia, which reached a settlement with the Justice Department this year, expects to move more than 400 people out by the end of the 2016 fiscal year.

Here in Georgia, about 360 developmentally disabled patients have left state hospitals over the past two years, health officials say, moving mostly into small group homes that house four people each. About 400 more will leave over the next three years, nearly emptying the state’s institutions of people with severe mental disabilities, autism and dementia.

Advocates for the disabled are hailing the move as akin to the demise of racial segregation. For the first time, people who have spent decades in hospital wards will live in the community, have some say in their day-to-day activities and get the opportunity to meet and mingle with their neighbors.

“Everybody has a right to live in the world,” said Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities, who supports the shift.

The entire story is here.

Tuesday, October 16, 2012

Former City Official’s Blog Chronicled His Fall From Grace and Plans for Suicide


By RUSS BUETTNER
The New York Times
Originally published October 7, 2012

After years of using his blog to settle scores with journalists, former fellow city officials and even his own father, Russell A. Harding began his final post with an unsettling mix of humility and humor.

“While you read this try and hear the Doors playing in the background for the right feel,” he wrote. “Just kidding, trying to lighten the mood.”

“Well, this is my last post,” he added. “I am hoping and praying that by the time you read this I have not botched this suicide attempt.”

By the time the 3,000-word post, “The End,” was posted on Sept. 30, Mr. Harding, 48, had taken his own life.

His body was found by the police at his apartment in Dobbs Ferry, N.Y., on Saturday, Sept. 29, apparently two days after he had committed suicide. A friend of Mr. Harding’s called the police there, and said he had received a letter that made him “concerned about his friend’s welfare,” Dobbs Ferry Police Sgt. Manuel Guevara said.

The entire story is here.

The Jumper Squad


By WENDY RUDERMAN
The New York Times
Originally published October 5, 2012

ON a concrete ledge off the upper deck of the George Washington Bridge, more than 200 feet above the swift and leaden Hudson River that November night, the two detectives gingerly approached the despondent man as he contemplated jumping.


The plunge, at a speed of more than 60 miles per hour, would surely kill him.

Detectives Marc Nell and Everald Taylor, tethered to the bridge and to their rescue truck with nylon harnesses and heavy rope, knew to resist the urge to pull the man to safety. It was not time yet.

“Tell me your name,” Detective Nell said, tapping into the emotional and psychological arsenal that he had acquired in training. “Talk to me.” “Think of your family.”

Sometimes the detectives do most or all of the talking. It does not always matter. What the detectives are probing for is not necessarily conveyed in words. They are looking for an opening. A moment of doubt.

“Once you see that light, you see their facial expression change, their body posture change, and you think: ‘Oh, I got them. O.K., they are not going anywhere,’ ” Detective Nell said. “It’s like when a boxer gets that shot and he knows that the opponent is wobbly and he just keeps going at that same spot.”

In this case, Detectives Nell and Eddie Torres, a third officer who had joined the rescue, did what they refer to as the Grab. They seized the man, pulling him off the ledge and over a guardrail.

Each year, the Police Department receives hundreds of 911 calls for so-called jumper jobs, or reports of people on bridges and rooftops threatening to jump. So far this year, that number is on track to surpass last year’s total, 519.

The entire story is here.

Thanks to Ed Lundeen for this story.


Monday, October 15, 2012

Letting Patients Read the Doctor’s Notes

By PAULINE W. CHEN, M.D.
The New York Times
Originally published on October 4, 2012

Here are some excerpts:


This patient’s experience, like those of so many others who have tried to obtain their medical records, came to mind this week when I read about the long-awaited results of a study in which patients were given complete access to their doctors’ notes. The findings, published in the Annals of Internal Medicine, do more than shed light on what patients want. They make our current ideas about transparency in the patient-doctor relationship a quaint artifact of the past.

Since 1996, when Congress passed the Health Insurance Portability and Accountability Act, or HIPAA, patients have had the right to read and even amend their own records.

In fact, few patients have ever consulted their own records. Most do not fully grasp the extent of their legal rights; and the few who have attempted to exercise them have often found themselves mired in a parallel universe filled with administrative regulations, small-print permission forms, added costs and repeated delays.


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For one year, the study, aptly called OpenNotes, allowed over 13,000 patients from three medical centers — the Beth Israel Deaconess Medical Center in Boston, the Geisinger Health System in Danville, Pa., and the Harborview Medical Center in Seattle — to have complete access to one part of their medical records, the notes that doctors wrote about them. Within days of seeing their doctors, patients received an e-mail inviting them to read the doctor’s signed note on a secure patient Web site. Two weeks before their return visit, patients received a second e-mail inviting them again to review their doctor’s note from the previous encounter.

After a year, almost all the patients were enthusiastic about the OpenNotes initiative.

Surprisingly, so were the majority of doctors.

The entire article is here.

The research from the Annals of Internal Medicine is here.

The Ups and Downs of Electronic Medical Records


By MILT FREUDENHEIM
The New York Times
Originally published October 8, 2012

The case for electronic medical records is compelling: They can make health care more efficient and less expensive, and improve the quality of care by making patients’ medical history easily accessible to all who treat them.

Small wonder that the idea has been promoted by the Obama administration, with strong bipartisan and industry support. The government has given $6.5 billion in incentives, and hospitals and doctors have spent billions more.

But as health care providers adopt electronic records, the challenges have proved daunting, with a potential for mix-ups and confusion that can be frustrating, costly and even dangerous.

Some doctors complain that the electronic systems are clunky and time-consuming, designed more for bureaucrats than physicians. Last month, for example, the public health system in Contra Costa County in California slowed to a crawl under a new information-technology system.

The entire story is here.

Sunday, October 14, 2012

Mirrored Morality: An Exploration of Moral Choice in Video Games

By Andrew J. Weaver, Ph.D., and Nicky Lewis, M.A.
CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING
Volume 15, Number 11, 2012
DOI: 10.1089/cyber.2012.0235


Abstract

This exploratory study was designed to examine how players make moral choices in video games and what effects these choices have on emotional responses to the games. Participants (n = 75) filled out a moral foundations questionnaire (MFQ) and then played through the first full act of the video game Fallout 3. Game play was recorded and content analyzed for the moral decisions made. Players also reported their enjoyment of and emotional reactions to the game and reflected on the decisions they made. The majority of players made moral decisions and behaved toward the nonplayer game characters they encountered as if these were actual interpersonal interactions. Individual differences in decision making were predicted by the MFQ. Behaving in antisocial ways did increase guilt, but had no impact on enjoyment.

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Discussion

As moral choices are increasingly utilized as plot devices in video games, they present a unique opportunity to examine the underlying factors involved in moral decision making.  This exploratory study indicates that moral decisions in games largely play out the same way that moral judgments in real-world interactions would. The suspension of disbelief that has long been a feature of fictional entertainment consumption occurred in this game context as well, with players often interacting with nonplayer characters as if they were real people, experiencing the same emotions (e.g., guilt) that they would feel in actual interpersonal interactions. In this study, we found that not only did most players avoid antisocial behavior, but they cited moral considerations for their behavior. Although a subset of the sample did describe their choices in strategic terms, moral disengagement was not typical in this context when a player was given moral agency.

The entire paper can be found here.

Saturday, October 13, 2012

Fake Peer Reviews, the Latest Form of Scientific Fraud, Fool Journals

By Josh Fischman
The Chronicle of Higher Education
Originally published September 30, 2012


Scientists appear to have figured out a new way to avoid any bad prepublication reviews that dissuade journals from publishing their articles: Write positive reviews themselves, under other people's names.

In incidents involving four scientists—the latest case coming to light two weeks ago—journal editors say authors got to critique their own papers by suggesting reviewers with contact e-mails that actually went to themselves.

The glowing endorsements got the work into Experimental Parasitology, Pharmaceutical Biology, and several other journals. Fake reviews even got a pair of mathematics articles into journals published by Elsevier, the academic publishing giant, which has a system in place intended to thwart such misconduct. The frauds have produced retractions of about 30 papers to date.

"I find it very shocking," said Laura Schmidt, publisher in charge of mathematics journals at Elsevier. "It's very serious, very manipulative, and very deliberate."

The entire story is here.

91 Are Charged With Fraud, Billing Millions to Medicare


By REUTERS
Originally published October 4, 2012


Ninety-one people including doctors, nurses and other medical professionals were charged criminally after an investigation of Medicare fraud that involved $430 million in false billing in seven cities, officials said on Thursday.

It was the government’s second big raid in recent months after a similar investigation in May involving $452 million in possible fraud in Medicare, the health program for the elderly and disabled.

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The investigation is part of an effort by the Obama administration to find health care savings.

The entire story is here.

Friday, October 12, 2012

May Doctors Help You to Die?

By Marcia Angell
The New York Review of Books
Published on October 11, 2012


On November 6, Massachusetts voters will decide whether a physician may provide a dying patient with medication to bring about a faster, easier death if the patient chooses. On the ballot will be a Death with Dignity Act that reads:

It is hereby declared that the public welfare requires a defined and safeguarded process by which an adult Massachusetts resident who has the capacity to make health care decisions and who has been determined by his or her attending and consulting physicians to be suffering from a terminal disease that will cause death within six months may obtain medication that the patient may self administer to end his or her life in a humane and dignified manner. It is further declared that the public welfare requires that such a process be entirely voluntary on the part of all participants, including the patient, his or her physicians, and any other health care provider or facility providing services or care to the patient.

If this ballot initiative passes, it will be binding, and Massachusetts will join Oregon, which implemented a virtually identical statute in 1998, and Washington, which did the same in 2009, as the only states where voters approved this form of physician-assisted dying, sometimes called aid-in-dying. (These terms are favored by proponents over the older term, physician-assisted suicide, because they distinguish it from the typical suicide in which someone with a normal life expectancy chooses death over life. Here the patient is near death from natural causes anyway, and chooses the timing and manner of an inevitable death.) Montana, through a 2009 decision by its Supreme Court, not a voter referendum, also permits physician-assisted dying.

The entire review is here.

Merciful Assistance or Physician-Assisted Killing?

By Ronald Pies, M.D.
psychcentral.com blog

Here are some excerpts:


From the standpoint of medical ethics, I see no fundamental moral difference in a doctor’s assisting a patient to jump off a bridge — without, of course, pushing him off — and a doctor’s prescribing a lethal dose of medication to “assist” in the patient’s suicide. The main difference is that, whereas anybody can assist a suicidal patient in climbing over a bridge railing, only physicians and a few other health care professionals are authorized by law to prescribe medication — and, in Oregon and Washington state, to prescribe lethal medication for “physician-assisted suicide” (PAS).

Of course, there are important procedural differences between my bridge scenario and the way PAS is handled in these states. There are numerous procedural safeguards in place to ensure that dying patients are thoroughly evaluated, and not pressured or coerced into requesting lethal medication — though the evidence is mixed as to how effective these safeguards have been. One study of physician-assisted suicide in Oregon and the Netherlands found no evidence that disadvantaged groups (such as the elderly or disabled) are being disproportionately affected by the laws (Battin et al). On the other hand, another study (Finlay and George) concluded that, “…there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.”

From a strictly ethical perspective, I believe physicians have no more business helping patients kill themselves with lethal drugs than they do helping patients jump off bridges — regardless of how “voluntary” the patient’s decision may be. Clearly, neither action is compatible with the traditional role of the physician as healer. Indeed, psychiatrist and ethicist Dr. Thomas Szasz has argued that “physician-assisted suicide” is merely a euphemism for “medical killing.” For these reasons, I am opposed to the November ballot initiative in Massachusetts for a measure that would allow terminally ill patients to be prescribed lethal drugs.

The entire blog post is here.

Thursday, October 11, 2012

Files Offer Glimpse Into Shooting Suspect


By JACK HEALY
The New York Times
Originally published September 28, 2012

Here is an excerpt:


The defendant, James E. Holmes, had been a graduate student in the neuroscience program at the University of Colorado, Denver, but he had struggled and was in the process of dropping out of the program by mid-June, about six weeks before the July 20 shootings.

The legal case against Mr. Holmes has proceeded with a high degree of secrecy, with the bulk of the case file hidden by court order from public view.

The judge in the case, William B. Sylvester, opened the file over the objections of prosecutors and defense lawyers, but he agreed to leave documents like affidavits and warrants under wraps. He allowed heavy redactions of motions and documents, meaning that entire pages of the case file are blacked out, obscuring their content and meaning.

After the killings, family members of victims and people who knew Mr. Holmes, 24, asked what warning signs he might have offered as he became more isolated and, according to the police, began to amass an arsenal of guns, bullets and explosives.

The entire article is here.

Prof whom Holmes allegedly threatened appears to be his psychiatrist Read more: Prof whom Holmes allegedly threatened appears to be his psychiatrist


By John Ingold and Jeremy P. Meyer
The Denver Post
Originally published September 29, 2012


The University of Colorado professor whom Aurora theater shooting suspect James Holmes allegedly threatened appears to be Holmes' psychiatrist, according to a court filing made public Friday.

In the filing, prosecutors assert that Holmes and Dr. Lynne Fenton ended their doctor-patient relationship after Holmes made threats to someone, who reported those threats to the CU police. Later in the filing, prosecutors appear to indicate that the person who contacted police was Fenton. In both cases, though, the name of the person contacting police is redacted.

"The relationship was terminated after the defendant made threats directed towards (redacted), who reported the matter to" the police, the filing states. Later on, prosecutors write: "[T]he defendant's professional relationship with (redacted) had been terminated after she reported threats to the CU police."

The entire article is here.

Wednesday, October 10, 2012

ONC advancing Blue Button, CDS standards efforts


Automating the Blue Button to Exchange PHI

Mary Mosquera
Senior Editor, Government Health IT
Originally published on September 26, 2012

Developers in an ONC voluntary community are beginning to drill down into what will be required to automate the Blue Button feature to exchange patient health information at the consumer’s request under different scenarios.

The Blue Button enables patients to view and download their information in simple text format and is currently available to veterans, military service members and Medicare beneficiaries. A few private sector health organizations have begun to make it available to their members.

The ONC’s Standards & Interoperability Framework community has just created three panels to identify standards and tools to push personal data to a specific location, such as using Direct secure messaging protocols and the Consolidated Clinical Document Architecture (CDA), and allowing a third-party application to access personal health data on demand, in a pull transmission, according to Doug Fridsma, MD, director of ONC’s Office of Standards and Interoperability and acting chief scientist.

The entire story is here.

Reducing the Risk of a Breach of PHI from Mobile Devices


Latest HHS Fine Hits The Massachusetts Eye and Ear Infirmary

by Rick Kam, ID Experts
Originally published on September 26, 2012

The Massachusetts Eye and Ear Infirmary and Massachusetts Eye and Ear Associates Inc. (MEEI), will pay $1.5 million to the Department of Health and Human Services (HHS) for potential violations of the HIPAA Security Rule. In the HHS release, they explain that it wasn’t just one issue or misstep that led to the fine, but rather a series of errors and inaction.

“…such as conducting a thorough analysis of the risk to the confidentiality of ePHI maintained on portable devices, implementing security measures sufficient to ensure the confidentiality of ePHI that MEEI created, maintained, and transmitted using portable devices, adopting and implementing policies and procedures to restrict access to ePHI to authorized users of portable devices, and adopting and implementing policies and procedures to address security incident identification, reporting, and response.”

The entire story is here.

Tuesday, October 9, 2012

Narrative, Poststructuralism, and Social Justice Current Practices in Narrative Therapy


By Gene Combs and Jill Freedman
The Counseling Psychologist

doi: 10.1177/0011000012460662
The Counseling Psychologist October 2012 vol. 40 no. 7 1033-1060


Abstract

This paper is a review of current practice in narrative therapy with a focus on how it is attractive and useful for therapists who wish to work for social justice. The authors describe narrative therapy’s roots in poststructuralist philosophy and social science. They illustrate its major theoretical constructs, including the narrative metaphor, Foucault’s notion of “modern power,” and narrative therapy’s emphasis on problems as separate from people. The authors then describe specific practices: narrative questions, externalizing conversations, utilizing the “absent but implicit,” the development and “thickening” of preferred stories, the documentation of preferred stories, outsider witness practices, and practices for connecting people around shared purposes. After reviewing research that supports narrative therapy as useful and effective, the authors specifically address the ways narrative therapy deals with issues of social justice, showing how its focus on the discourses of modern power helps therapists be especially attuned to these issues.

Contact information: Gene Combs, NorthShore University HealthSystem, 2050 Pfingsten Rd., Glenview, IL, 60026, USA

President Obama Unveils Landmark Actions To Fight Human Trafficking


The president said it was time to call human trafficking by its real name: "modern slavery."

By ELIZABETH FLOCK
US News and World Report
Originally published September 26, 2012


President Barack Obama unveiled major actions to fight human trafficking at home and abroad in a speech at the Clinton Global Initiative's annual meeting Tuesday, a problem the U.S. has long sought to control.

Just hours after his Republican challenger Mitt Romney spoke to the same audience, arguing broadly that free trade and aid were the key to a better world, Obama chose to focus his speech on the single issue of trafficking, and what the U.S. can do to stop it. Obama told the assembled audience it was time to turn the focus on fighting trafficking within American borders.

"The ugly truth is that this goes on right here," he said. "It's the migrant worker unable to pay off the debt to his trafficker... The teenage girl—beaten, forced to walk the streets. This should not be happening in America."

The president also said it was time to call human trafficking by its real name: "modern slavery." Obama's speech came just days after the 150th anniversary of the Emancipation Proclamation, the executive order issued by President Abraham Lincoln in 1863 that freed millions of slaves across the United States.

The entire story is here.

Monday, October 8, 2012

In Plain View: How child molesters get away with it.

By Malcolm Gladwell
The New Yorker
Originally published September 24, 2012

Here are some excerpts:

The pedophile is often imagined as the dishevelled old man baldly offering candy to preschoolers. But the truth is that most of the time we have no clue what we are dealing with. A fellow-teacher at Mr. Clay’s school, whose son was one of those who complained of being fondled, went directly to Clay after she heard the allegations. “I didn’t do anything to those little boys,” Clay responded. “I’m innocent. . . . Would you and your husband stand beside me if it goes to court?” Of course, they said. People didn’t believe that Clay was a pedophile because people liked Clay—without realizing that Clay was in the business of being likable.

Did anyone at Penn State understand what they were dealing with, either? Here was a man who built a sophisticated, multimillion-dollar, fully integrated grooming operation, outsourcing to child-care professionals the task of locating vulnerable children—all the while playing the role of lovable goofball. “If Sandusky did not have such a human side,” Sports Illustrateds Jack McCallum wrote, in 1999, “there would be a temptation around Happy Valley to canonize him.” A week later, Bill Lyon, of the Philadelphia Inquirer, paid tribute to Sandusky’s selflessness. “In more than one motel hallway, whenever you encountered him and offered what sounded like even the vaguest sort of compliment, he would blush and an engaging, lopsided grin of modesty would wrap its way around his face,” Lyon wrote. “He isn’t in this business for recognition. His defense plays out in front of millions. But when he opens the door and invites in another stray, there is no audience. The ennobling measure of the man is that he has chosen the work that is done without public notice.”

(cut)

This is standard child-molester tradecraft. The successful pedophile does not select his targets arbitrarily. He culls them from a larger pool, testing and probing until he finds the most vulnerable. Clay, for example, first put himself in a place with easy access to children—an elementary school. Then he worked his way through his class. He began by simply asking boys if they wanted to stay after school. “Those who could not do so without parental permission were screened out,” van Dam writes. Children with vigilant parents are too risky. Those who remained were then caressed on the back, first over the shirt and then, if there was no objection from the child, under the shirt. “The child’s response was evaluated by waiting to see what was reported to the parents,” she goes on. “Parents inquiring about this behavior were told by Mr. Clay that he had simply been checking their child for signs of chicken pox. Those children were not targeted further.” The rest were “selected for more contact,” gradually moving below the belt and then to the genitals.

The child molester’s key strategy is one of escalation, desensitizing the target with an ever-expanding touch. In interviews and autobiographies, pedophiles describe their escalation techniques like fly fishermen comparing lures.

The entire story is here.

Thanks to Rick Small for this story.

A Dangerous Remedy (2 Letters)


Two Letters to the Editor from the New York Times published on October 1, 2012.

One is important to understand how psychotropics are currently being used on a daily basis and the second to underscore how psychological treatments are overlooked.

To the Editor:

Re “A Call for Caution on Antipsychotic Drugs,” (Mind, Sept. 25): “A call for caution” is indeed needed and long overdue to curb the inappropriate overuse of antipsychotics. As the author notes, the use of these highly potent and expensive drugs is drastically out of proportion to the appropriate target population: individuals with schizophrenia and bipolar disorder.

The misuse of antipsychotics in nursing homes in particular is a widespread yet preventable problem. Approximately one in four residents are given antipsychotics. The percentage of residents with dementia on these drugs is even higher. Too often, they are used as a form of chemical restraint, as a substitute for good care and adequate staffing. Contrary to what the article states, they are harmful for elderly people with dementia, greatly increasing the risk of stroke, heart attack, falls and even death.

Federal standards have long prohibited the inappropriate use of antipsychotics in nursing homes. With increased public knowledge and vigorous enforcement, hopefully we can make those standards a reality for vulnerable residents.

Richard Mollot

Manhattan

To the Editor:

There was no mention in Dr. Richard A. Friedman’s article about the proven effectiveness of psychological treatment, such as cognitive behavioral therapy, for nonpsychotic disorders. Instead, Dr. Friedman suggests that patients suffering from anxiety or depression take other, less powerful medications. By not recommending psychotherapy for the treatment of anxiety and depression, Dr. Friedman is perpetuating the mind-set that all psychiatric disorders should be treated with medicine, which in effect has created a climate that encourages the off-label use of antipsychotics.

Patricia Thornton

Manhattan

These can be found here.

Sunday, October 7, 2012

NYC schools dispensing morning-after pill to girls

By By Karen Matthewslindsey Tanner
Bloomberg BusinessWeek
Originally published September 26, 2012


 It's a campaign believed to be unprecedented in its size and aggressiveness: New York City is dispensing the morning-after pill to girls as young as 14 at more than 50 public high schools, sometimes even before they have had sex.

The effort to combat teen pregnancy in the nation's largest city contrasts sharply with the views of politicians and school systems in more conservative parts of the country.

Valerie Huber, president of the National Abstinence Education Association in Washington, calls it "a terrible case once again of bigotry of low expectations" — presuming that teen girls will have sex anyway, and effectively endorsing that.

But some doctors say more schools should follow New York's lead.

Emergency contraception is safe and effective "if you use it in a timely fashion. It provides relief or solace to a young woman or man who has made a mistake but doesn't want to have to live with that mistake for the rest of their lives," said Dr. Cora Breuner, a Seattle physician and member of an American Academy of Pediatrics' committee on teen health.

The entire story is here.

Illinois cannot make pharmacists give 'morning after' pill: court

By Mary Wisniewski
Reuters
Originally published September 21, 2012

An Illinois appellate court Friday affirmed a lower court finding that the state cannot force pharmacies and pharmacists to sell emergency contraceptives - also known as "morning after pills" - if they have religious objections.

(cut)

"We are dismayed that the court expressly refused to consider the interests of women who are seeking lawful prescription medication and essentially held that the religious practice of individuals trumps women's health care," said ACLU spokesman Ed Yohnka. "We think the court could not be more wrong."

The entire story is here.

Abortion Rates Fall When Birth Control Is Free


By Salynn Boyles
WebMD Health News 
Originally published on October 4, 2012


Abortions and unplanned pregnancies dropped dramatically in a new study when women and teenaged girls were provided birth control at no cost.

The women and girls were also more likely to choose IUDs or contraceptive implants when cost was not an issue.

Family planning advocates say the study shows the potential of the health reform law (now known by both supporters and opponents as Obamacare) to reduce unplanned pregnancies nationwide.

(cut)

About half of all pregnancies in the U.S. are unplanned, and about half of these pregnancies happen when birth control is not used.

The rest happen when contraception is used only some of the time or is used incorrectly.

The new study, published online today in the journal Obstetrics & Gynecology, included close to 9,300 sexually active women and teen girls at risk for having an unplanned pregnancy.

While the women were offered any FDA-approved method of contraception at no cost, the researchers made sure they knew that IUDs and implants were the most effective.

Researcher Jeff Peipert, MD, of Washington University in St. Louis, says around 3 out of 4 study participants opted for the long-acting methods.

“That was a shocker,” he says. “We had hoped to get maybe 15% of the women to choose IUDs or implants, but it was closer to 75%. That made all the difference.”

The entire story is here.

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice opinion can be found here.

Saturday, October 6, 2012

Cheating

By Herman Berliner
Provost Prose Blog
Originally published September 23, 2012

Here is an excerpt:

Cheating doesn’t just start in college.  It starts much earlier and is equally pervasive in much of middle and high school education. It actually starts earlier in elementary school and unfortunately parents may be playing an enabling role in the cheating that is going on.  We all recognize that parents play a critical role in the education of their children and that teachers together with parents are key factors in the success of children.  But where should parents draw the line in helping their kids.  My wife and I both read to and listened to the reading of both of our kids when they were very young.  I hope we helped them read earlier and more fluently.  But we have never felt that their homework was our homework and we never hovered over them until their assignments were perfection.  And we never have felt that their grades are our grades and that we had to help them in any way possible to get the highest grade possible.

The entire blog post is here.

Cheating in College


By Scott Jaschik
Inside Higher Ed
Originally published on September 27, 2012


A scandal at Harvard University has many educators talking about cheating and whether anything can be done about it. Experts say that many students arrive in college already skilled at and not morally troubled by cheating, and scandals at top high schools back up this point of view. What, if anything, can professors and colleges? These issues are explored in a new book, Cheating at College: Why Students Do It and What Educators Can Do About It (Johns Hopkins University Press). The authors are Donald L. McCabe, professor of management and global business at the Rutgers University Business School; Kenneth D. Butterfield, associate professor of management, information systems and entrepreneurship at Washington State University; and Linda K. Treviño, professor of organizational behavior at Pennsylvania State University. They responded via e-mail to questions about the book.

Q: Is cheating getting worse? Or do those who say that only imagine a golden age when academic honesty prevailed?

A: Interestingly, the hard data we present in our book suggest cheating may now be on the decline. Similar results have been obtained by the Josephson Institute in their work with high schools. After a period of steep increases, some moderation in cheating was reported in their 2010 report. They will issue a new report in October 2012 and it will be most interesting to see what’s happening now. But, it is important to keep in mind that the data are self-reported and, in our studies, we have moved from print surveys to online surveys. That move may have affected the numbers we are seeing, possibly making the picture look rosier than it really is.

In our college work, we have observed a kind of ebb and flow in our data – some types of cheating seem to have increased (surprisingly not necessarily those related to the Internet) and others seem to be on the wane. However, there seems to be little question, based on various comments offered by students, that changes in student attitudes can’t be ignored. Many students have indicated that they have had no involvement in certain types of cheating, but in open-ended questions near the end of our survey, they say that they actually have engaged in these actions, but when they did it, it was not cheating because…. Of course, this may simply be a rationalization process so students don’t have to admit, maybe even to themselves, that they’ve actually cheated.

The entire story is here.

Friday, October 5, 2012

Dilemma 18: Co-authorship with a Former Patient

Dr. Jordan is a psychologist who typically works with a wide variety of patients.  At the end of the day, he listens to voicemail messages to learn that a former patient is reaching out to him for a request. 

Prior to returning the call, Dr. Jordan reviews the patient’s chart.  The patient had been in treatment for about 10 months on a weekly basis.  The treatment notes indicate that she dropped out of therapy about one year ago.  She stopped therapy because her insurance changed and Dr. Jordan was not an in-network provider.  The therapy focused on depression and anxiety related to work-related issues, interpersonal limitations, and relationship difficulties.  Some of the sessions focused on a sexually abusive relationship between a basketball coach and the patient when she was age 13 to 16.    

Dr. Jordan returns the phone call.  After the initial greetings, the former patient indicates that she has finally started to write down more thoughts, memories, and recollections about her abusive experiences.  She stated that Dr. Jordan recommended that she write down her memories.  She recalled that he agreed that it could make a good book.  She stated she wanted to include some education around sexual abuse and tell her story in a healthy, therapeutic manner.

When attempting to clarify the request, the former patient is not asking to return to therapy, but to have Dr. Jordan become the co-author or a consultant for the book.  Dr. Jordan thanked her for the compliment and indicated that he needed to think about the request.  He promised to call her back within a week.

Dr. Jordan calls you on the phone for an ethics consultation.

What are the ethical issues involved in this case?

What are some possible suggestions for Dr. Jordan?

If you were Dr. Jordan, how would you feel about this request?

Thursday, October 4, 2012

Liberating Reason From the Passions: Overriding Intuitionist Moral Judgments Through Emotion Reappraisal


Matthew Feinberg, Robb Willer, Olga Antonenko and Oliver P. John
Psychological Science, 2012; 23 (7): 788 DOI: 10.1177/0956797611434747

Abstract

A classic problem in moral psychology concerns whether and when moral judgments are driven by intuition versus deliberate reasoning. In this investigation, we explored the role of reappraisal, an emotion-regulation strategy that involves construing an emotion-eliciting situation in a way that diminishes the intensity of the emotional experience. We hypothesized that although emotional reactions evoke initial moral intuitions, reappraisal weakens the influence of these intuitions, leading to more deliberative moral judgments. Three studies of moral judgments in emotionally evocative, disgust-eliciting moral dilemmas supported our hypothesis. A greater tendency to reappraise was related to fewer intuition-based judgments (Study 1). Content analysis of open-ended descriptions of moral-reasoning processes revealed that reappraisal was associated with longer time spent in deliberation and with fewer intuitionist moral judgments (Study 2). Finally, in comparison with participants who simply watched an emotion-inducing film, participants who had been instructed to reappraise their reactions while watching the film subsequently reported less intense emotional reactions to moral dilemmas, and these dampened reactions led, in turn, to fewer intuitionist moral judgments (Study 3).


'Conversion therapy' for gay patients unethical, says professional body

British Association for Counselling and Psychotherapy formalises policy change for 30,000-strong membership

Peter Walker
guardian.co.uk
Originally published Monday 1 October 2012


Britain's biggest professional body for psychotherapists has instructed members that it is unethical for them to attempt to "convert" gay people to being heterosexual, formalising a policy change long demanded by rights groups.

The British Association for Counselling and Psychotherapy has written to its near-30,000 members to inform them of the new guidelines. The letter says the BACP "opposes any psychological treatment such as 'reparative' or 'conversion' therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality". The body adds that it recognises World Health Organisation policy that says such therapies can cause severe harm to an individual's mental and physical health.

The statement, drawn up by the board of governors, ends: "BACP believes that socially inclusive, non-judgmental attitudes to people who identify across the diverse range of human sexualities will have positive consequences for those individuals, as well as for the wider society in which they live. There is no scientific, rational or ethical reason to treat people who identify within a range of human sexualities any differently from those who identify solely as heterosexual."

The entire story is here.

Christian group files suit to stop gay therapy ban

By The Associate Press
Originally published October 2, 2012


A Christian legal group has filed a lawsuit to overturn a first-of-its-kind California law that prohibits licensed mental health professionals from practicing therapies aimed at making gay and lesbian teenagers straight.

The California-based Pacific Justice Institute challenged the law signed Saturday by Gov. Jerry Brown. The lawsuit was filed late Monday in U.S. District Court in Sacramento.

The institute filed the suit on behalf of a psychiatrist and a marriage and family therapist who is also a church pastor in San Diego. It also names as a plaintiff Aaron Bitzer, a Culver City man who says he has benefited from the "reparative" therapy.

The lawsuit claims the law, which is scheduled to take effect Jan. 1, violates First Amendment and equal protection rights.

Meanwhile, gay rights advocates are making plans to get other states to join California in banning such therapies.

Brown called the therapies "quackery" that "have no basis in science or medicine."

The entire story is here.


Wednesday, October 3, 2012

Suicide Outbreak Prompts CDC Assessment

Community education and availability of mental health resources are called essential in efforts to limit suicidal behavior.

By Christopher White
Psychiatric News
Originally published September 21, 2012

In the first five months of this year, 11 young people completed suicide in Kent and Sussex counties in Delaware, an increase from the yearly average of four in those aged 12 to 21 from 2009 to 2011.

Reflecting the state’s concern about this troubling development, the Delaware Department of Health and Human Services asked the federal Centers for Disease Control and Prevention (CDC) to conduct an epidemiological study to determine the rates of fatal and nonfatal suicide behaviors in the area, analyze risk factors, and recommend strategies to prevent future suicides.

Of the 11 decedents, four were students at the same high school, two were students at other local high schools, one was a student at a middle school, one had dropped out of high school, two had graduated from area high schools and were still living in Sussex County, and one was an adult with unknown education history.


The entire story is here.

Suicide, Not Car Crashes, #1 Cause of Injury Death


By Jennifer Warner
WebMD Health News
Originally published September 20, 2012

Suicide has overtaken car crashes as the leading cause of injury-related deaths in the U.S.

(cut)

The top five leading causes of injury-related deaths were:

1. Suicide
2. Motor vehicle crashes
3. Poisoning
4. Falls
5. Homicide

Researchers say the findings demonstrate that suicide is now a global public health issue.

"Our finding that suicide now accounts for more deaths than do traffic crashes echoes similar findings for the European Union, Canada, and China," they write.

Researchers say deaths from unintentional poisoning rose, in part, because of a sharp rise in prescription drug overdoses.

The entire article is here.

Tuesday, October 2, 2012

Is A Competitive Health Care Model All It’s Cracked Up To Be?

By Julie Appleby and Marilyn Werber Serafini
Kaiser Health News, in conjunction with The Atlantic
Originally published on September 20, 2012


Republican vice presidential nominee Paul Ryan says his proposal to overhaul Medicare would use market competition to tame costs in the government health program relied on by almost 50 million people.

As models, he often cites the health program for federal employees – including members of Congress -- and Medicare’s prescription drug program. "It works with federal employees, it works with the prescription drug benefit, and more to the point, it saves Medicare," Ryan said on "Meet the Press" in April.

Both of those programs get high marks from beneficiaries for the choices they offer. But their track record on cost control is more complicated, raising questions about whether the competitive model is in fact the silver bullet that backers have suggested. 

The federal employee health insurance program is often touted as holding down the increase in premium prices more successfully than private workplace plans or government-run programs. But a data analysis done for Kaiser Health News (KHN) and interviews with experts shows it has not held down costs per enrollee as efficiently as Medicare during the past decade.

Average spending in the federal workers’ program grew at 7.1 percent annually per enrollee, higher than the 5.8 percent growth rate for traditional Medicare – excluding the drug program -- over the decade ending in 2010, according to data analyzed at KHN’s request.  The analysis, based on 10-year averages, was done by Walton Francis, a consultant and principal author for 30 years of the Consumers’ Checkbook Guide to Health Plans for Federal Employees.

California Is First State to Ban Gay ‘Cure’ for Minors


By ERIK ECKHOLM
The New York Times
Originally published September 30, 2012

California has become the first state to ban the use for minors of disputed therapies to “overcome” homosexuality, a step hailed by gay rights groups across the country that say the therapies have caused dangerous emotional harm to gay and lesbian teenagers.

“This bill bans nonscientific ‘therapies’ that have driven young people to depression and suicide,” Gov. Jerry Brown said in a statement on Saturday after he signed the bill into law. “These practices have no basis in science or medicine, and they will now be relegated to the dustbin of quackery.”

The law, which is to take effect on Jan. 1, states that no “mental health provider” shall provide minors with therapy intended to change their sexual orientation, including efforts to “change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.”

The entire story is here.


Monday, October 1, 2012

Spontaneous giving and calculated greed


D. G. Rand, J. D. Greene & M. A. Nowak
Nature 489, pp 427-430 – doi:10.1038/nature11467

Abstract

Cooperation is central to human social behaviour. However, choosing to cooperate requires individuals to incur a personal cost to benefit others. Here we explore the cognitive basis of cooperative decision-making in humans using a dual-process framework. We ask whether people are predisposed towards selfishness, behaving cooperatively only through active self-control; or whether they are intuitively cooperative, with reflection and prospective reasoning favouring ‘rational’ self-interest. To investigate this issue, we perform ten studies using economic games. We find that across a range of experimental designs, subjects who reach their decisions more quickly are more cooperative. Furthermore, forcing subjects to decide quickly increases contributions, whereas instructing them to reflect and forcing them to decide slowly decreases contributions. Finally, an induction that primes subjects to trust their intuitions increases contributions compared with an induction that promotes greater reflection. To explain these results, we propose that cooperation is intuitive because cooperative heuristics are developed in daily life where cooperation is typically advantageous. We then validate predictions generated by this proposed mechanism. Our results provide convergent evidence that intuition supports cooperation in social dilemmas, and that reflection can undermine these cooperative impulses.


Here is a portion of a review of this article:

The researchers wanted to know whether people's first impulse is cooperative or selfish. To find out, they started by looking at how quickly different people made their choices, and found that faster deciders were more likely to contribute to the common good. 

Next they forced people to go fast or to stop and think, and found the same thing: Faster deciders tended to be more cooperative, and the people who had to stop and think gave less.

Finally, the researchers tested their hypothesis by manipulating people's mindsets. They asked some people to think about the benefits of intuition before choosing how much to contribute. Others were asked to think about the virtues of careful reasoning. Once again, intuition promoted cooperation, and deliberation did the opposite.

While some might interpret the results as suggesting that cooperation is "innate" or "hard-wired," if anything they highlight the role of experience. People who had better opinions of those around them in everyday life showed more cooperative impulses in these experiments, and previous experience with these kinds of studies eroded those impulses.