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, July 31, 2013

Dementia Rate Is Found to Drop Sharply, as Forecast

By GINA KOLATA
The New York Times
Published: July 16, 2013

A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, the strongest evidence yet of a trend some experts had hoped would materialize.

Another recent study, conducted in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier. Nearly one-quarter of those assessed in 2010 scored at the highest level, a rate twice that of those tested in 1998. The percentage severely impaired fell to 17 percent from 22 percent.

The entire story is here.

Most U.S. Health Spending Is Exploding — but Not for Mental Health

By Catherine Rampell
The New York Times Blog - Economix
Originally published July 2, 2013

Here is an excerpt:

Mental health spending, both public and private, was about $150 billion in 2009, more than double its level in inflation-adjusted terms in 1986, according to a recent article in Health Affairs. But the overall economy also about doubled during that time. As a result, direct mental health spending has remained roughly 1 percent of the economy since 1986, while total health spending climbed from about 10 percent of gross domestic product in 1986 to nearly 17 percent in 2009.


Thanks to Vince Bellwoar for this story.

Tuesday, July 30, 2013

A Right to Die, A Will to Live

By Margaret Cheatham Williams
The New York Times
Originally posted July 17, 2013

As a bioethicist, Peggy Battin fought for the right of people to end their own lives. After her husband’s cycling accident, her field of study turned unbearably personal.

Autonomy and the Unintended Legal Consequences of Emerging Neurotherapies

By Jennifer A. Chandler
Social Science Research Network
Published April 8, 2011

One of the ethical issues that has been raised recently regarding emerging neurotherapies, is that people will be coerced explicitly or implicitly in the workplace or in schools to take cognitive enhancing drugs.

This article builds on this discussion by showing how the law may pressure people to adopt emerging neurotherapies. It focuses on a range of private law doctrines that, unlike the criminal law, do not come up very often in neuroethical discussions. Three doctrines - the doctrine of mitigation, the standard of care in negligence, and child custody determinations in family law – are addressed to show how the law may pressure people to consent to treatment by offering a choice between accepting medical treatment and suffering a legal disadvantage. The doctrines considered in this article apply indirect pressure to submit to treatment, unlike court-ordered medical treatment, which applies direct pressure and is not addressed here.

The outcome of this discussion is to show that there is a greater range of social pressures that may encourage the uptake of novel neurotherapies than one might initially think. Once treatments that were developed and offered with therapeutic benefits in mind become available, their existence gives rise to unintended legal consequences. This certainly does not mean we should cease developing new therapies that may be of tremendous benefit to patients, but it does raise some questions for physicians and for legal policy-makers. How should physicians, who are required by medical ethical principles to obtain valid consent to treatment, react to a patient’s reluctant consent that is driven by legal pressure? From the legal policy perspective, are our legal doctrines satisfactory or should they be changed because, for example, they unduly promote the collective interest over individual freedom to reject medical treatment or because they channel us toward economically efficient treatments to the detriment of more costly but potentially superior approaches of dealing with behavioural problems?


The entire article is here.

Monday, July 29, 2013

Connecticut Mental Health Lawsuit Takes Insurers To Task

High Co-pays and issue in High Profile Case

By JAY STAPLETON
Connecticut Law Tribune
Originally published July 12, 2013

A Connecticut law firm has taken the lead in a high-profile federal lawsuit that accuses a group of insurance companies of overcharging for mental health services, prompting thousands of vulnerable patients to avoid treatment.

In the American Psychiatric Association v. Anthem Health Plans lawsuit, the firm of Murtha Cullina was hired as chief legal counsel for the plaintiffs. Attorney Marie Pepe VanDerLaan of the firm's Hartford office, the lead lawyer in the case, filed the complaint on the APA's behalf in U.S. District Court in New Haven.

At the heart of the claim is that the insurance company manipulated billing statements in order to charge higher co-pays for patients being treated for mental disorders than those required for patients with physical ailments. The APA is a lead plaintiff in the case, joined by psychologist Susan Savulak of Newington and several of her patients.

The entire article is here.

Kentucky’s Rush Into Medicaid Managed Care: A Cautionary Tale For Other States

By Jenni Bergal
Kaiser Health News, in conjunction with the Washington Post
Originally published July 15, 2013

Here is an excerpt

Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread.

Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.

Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid, the state-federal program for the poor and disabled, to managed care in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.

The entire story is here.

Sunday, July 28, 2013

Peter Attia: What if we're wrong about diabetes?

As a young ER doctor, Peter Attia felt contempt for a patient with diabetes. She was overweight, he thought, and thus responsible for the fact that she needed a foot amputation. But years later, Attia received an unpleasant medical surprise that led him to wonder: is our understanding of diabetes right? Could the precursors to diabetes cause obesity, and not the other way around? A look at how assumptions may be leading us to wage the wrong medical war.




Poll: Most Americans Don’t Want Congress to Repeal Obamacare

By Alex Roarty
National Journal
July 22, 2013

Americans aren’t ready to repeal Obamacare. But that doesn’t mean they think its implementation is going well.

A majority of adults don’t want to repeal the Affordable Care Act, according to the latest United Technologies/National Journal Congressional Connection Poll, preferring instead to either spend more on its implementation or wait to see if changes are needed later.

But based on recent news that the White House is delaying its employer health insurance mandate, the public appears convinced that the law’s implementation is going poorly. A majority of Americans say the one-year delay is a sign the White House is ill-prepared for a law already facing mounting problems; only slightly more than one-third of adults say putting off the requirement shows the president wants to make sure implementation goes smoothly.

The entire article is here.

Saturday, July 27, 2013

New Ethical And Legal Issues Associated With Cyberbullying On College Campuses

Medical News Today
Originally published July 14, 2013

Cyberbullying in the college environment can pose serious consequences for students' living and learning environments, including physical endangerment, according to newly published research by a UT Arlington associate education professor.

Jiyoon Yoon, director of the Early Childhood - Grade 6 Program for the UT Arlington College of Education and Health Professions, co-authored the paper "Cyberbullying Presence, Extent, and Forms in a Midwestern Post-secondary Institution," * which appears in the June 2013 issue of Information Systems Education Journal.

The researchers found that most respondents considered cyberbullying to be more prevalent at the secondary school level. But respondents said harassment via social media, text message or other electronic communications can be pernicious in the college environment and merited official response from administrators.

The entire story is here.

The research article can be found here.

Social networking ethics: Developing best practices for the new small world.

Lannin, Daniel G.; Scott, Norman A.
Professional Psychology: Research and Practice, Vol 44(3), Jun 2013, 135-141.
doi: 10.1037/a0031794

Emerging trends online, and especially in social network sites, may be creating an environment for psychologists where transparency is increasingly unavoidable. Thus, most psychological practitioners may now have to engage in small world ethics—ethical acuity that requires an application of ethical principles to the increasingly interconnected and transparent world that is burgeoning from online culture. Fortunately, rural psychology has already provided a helpful roadmap for how to demonstrate flexibility and prudence when applying ethical principles in cultures with great transparency. Therefore, professional psychologists and psychologists in training may need to draw upon this wisdom when conceptualizing best online practices for the field that relate to social networking and personal online activity. To remain relevant, psychotherapy must adapt to the new digital culture but maintain its identity as a profession guided by its historical values and ethical principles.

The article can be found here.

Click here for one example of a social media policy via Dr. Keely Kolmes, psychologist and social media guru.

Thanks to Dr. Patricia Fox for this information.

Friday, July 26, 2013

Recent Findings Force Scientists To Rethink The Rules Of Neuroimaging

MedicalNewsToday.com
Originally published on July 13, 2013

Here is an excerpt:

Brain mapping experiments all share a basic logic. In the simplest type of experiment, researchers compare brain activity while participants perform an experimental task and a control task. The experimental task might involve showing participants a noun, such as the word "cake," and asking them to say aloud a verb that goes with that noun, for instance "eat." The control task might involve asking participants to simply say the word they see aloud.

"The idea here is that the control task involves some of the same cognitive processes as the experimental task, in this case perceptual and articulatory processes," Jack explained. "But there is at least one process that is different - the act of selecting a semantically appropriate word from a different lexical category."

The entire article is here.

The original paper is here.

Low Hopes, High Expectations: Expectancy Effects and the Replicability of Behavioral Experiments

By Olivier Klein and others
Perspectives on Psychological Science 7(6) 572–584
DOI: 10.1177/1745691612463704
http://pps.sagepub.com

This article revisits two classical issues in experimental methodology: experimenter bias and demand characteristics. We report a content analysis of the method section of experiments reported in two psychology journals (Psychological Science and the Journal of Personality and Social Psychology), focusing on aspects of the procedure associated with these two phenomena, such as mention of the presence of the experimenter, suspicion probing, and handling of deception. We note that such information is very often absent, which prevents observers from gauging the extent to which such factors influence the results. We consider the reasons that may explain this omission, including the automatization of psychology experiments, the evolution of research topics, and, most important, a view of research participants as passive receptacles of stimuli. Using a situated social cognition perspective, we emphasize the importance of integrating the social context of experiments in the explanation of psychological phenomena. We illustrate this argument via a controversy on stereotype-based behavioral
priming effects.

The entire article is here.

Thursday, July 25, 2013

Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs

Light, Donald W., Lexchin, Joel and Darrow, Jonathan J. , Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs (June 1, 2013). Journal of Law, Medicine and Ethics, Vol. 14, No. 3, 2013.

Abstract:  

Over the past 35 years, patients have suffered from a largely hidden epidemic of side effects from drugs that usually have few offsetting benefits. The pharmaceutical industry has corrupted the practice of medicine through its influence over what drugs are developed, how they are tested, and how medical knowledge is created. Since 1906, heavy commercial influence has compromised Congressional legislation to protect the public from unsafe drugs. The authorization of user fees in 1992 has turned drug companies into the FDA’s prime clients, deepening the regulatory and cultural capture of the agency. Industry has demanded shorter average review times and, with less time to thoroughly review evidence, increased hospitalizations and deaths have resulted. Meeting the needs of the drug companies has taken priority over meeting the needs of patients. Unless this corruption of regulatory intent is reversed, the situation will continue to deteriorate. We offer practical suggestions including: separating the funding of clinical trials from their conduct, analysis, and publication: independent FDA leadership; full public funding for all FDA activities; measures to discourage R&D on drugs with few if any new clinical benefits; and the creation of a National Drug Safety Board.

The entire article is here and available for download.

EHR Adoption Steady, but More Work Needed

By David Pittman
MedPage Today
Originally published July 9, 2013

Physicians are continuing to adopt electronic health records at a steady clip, but more work is needed to have those systems communicate with each other, according to two studies published Tuesday.

In 2012, 72% of physicians had adopted some type of EHR system and 38.2% had capabilities required for a basic system (P<0.05), a review by the CDC's National Center for Health Statistics in Hyattsville, Md., found.

The number of basic EHR adopters was up from just over 25% in 2010, Chun-Ju Hsiao, PhD, and colleagues reported in a study that appeared online in Health Affairs. A basic EHR was defined as having seven capabilities including recording patient history and clinical notes, viewing lab results and imaging reports, and using computerized prescription ordering.

The entire story is here.

Wednesday, July 24, 2013

The Evolutionary Ethics of E. O. Wilson

By Whitley Kaufman
The New Atlantis
Winter/Spring 2013

In his new book The Social Conquest of Earth (2012), naturalist E. O. Wilson argues that our best chance at understanding and advancing morality will come when we “explain the origin of religion and morality as special events in the evolutionary history of humanity driven by natural selection.” This is a bold claim, yet a familiar one for Wilson, who has been advocating something like this approach to human morality ever since his landmark 1975 work Sociobiology.

In that book, Wilson provocatively argued that “scientists and humanists should consider together the possibility that the time has come for ethics to be removed temporarily from the hands of the philosophers” and that ethics should instead be “biologicized”: questions once debated seemingly without end by philosophers will be settled by biologists using the same methods by which they have explained digestion, reproduction, and all of the other evolved drives and functions of the body.

The unification of science and morality, on Wilson’s count, would be a much-needed revolution for ethics. But it has also long been one of the desiderata of the Enlightenment project — which has been so successful in fulfilling its promise of advancing our scientific knowledge and our material wellbeing, yet seems to have made so little progress in settling debates over ethics. The consilience of the human and natural sciences that Wilson’s sociobiological project promises would carry on the scientific method’s “unrelenting application of reason” to the field of ethics, and finally begin to establish a stable, wise, and enduring ethical code for the future.

The entire story is here.

Senate panel OKs bill banning anti-gay job bias

By SAM HANANEL
The Associated Press
Originally published on July 10, 2013

Gay rights advocates notched another victory Wednesday after a Senate panel approved a bill that would prohibit employers from discriminating against workers on the basis of sexual orientation or gender identity.

The measure won support from all the Democrats and three Republicans on the 22-member committee, signaling it has a strong chance of passage in the full Senate.

The vote is another sign of rapidly changing attitudes on gay rights in Congress and the nation. It comes just two weeks after the Supreme Court ruled that same-sex spouses are entitled to the same federal benefits as other married couples in states where gay marriage is legal.

The entire story is here.

Tuesday, July 23, 2013

The Ethics of Whistleblowing - Part 1

By Ed O'Neill
The Mises Daily
Originally published July 8, 2013

Recent revelations about the extent and details of the massive NSA surveillance program have been made possible mostly by the actions of a single whistleblower, Edward Snowden, presently in hiding from the wrath of the US government, whose shameful and frightening secrets he has now made public knowledge. Despite repeated denials by its officials, it is now evident that the NSA runs a data-collection and spying network which collects masses of data on the private communications of non-US citizens, and some private communications on US citizens. It does so without requirement for any individual warrants for its targets, and without requirement for any probable cause with respect to any of the individuals whose communications are collected. Instead, the entire program operates under a broad procedure-based warrant system, whereby a special clandestine court hears submissions from the government in secret and then dutifully approves general procedures for mass surveillance, without any adversarial argument being raised by any other party. The warrants allow mass surveillance and storage of data at the discretion of NSA analysts, and these warrants are clearly at odds with the principle of eschewing unreasonable searches.[1]

Proving the old adage that no good deed goes unpunished, Snowden is presently facing charges from the US government for theft of government property and unauthorized disclosure of defense and intelligence material.[2] He is also subject to widespread vilification in the establishment media, where he has been branded as a “traitor” and a “cross-dressing Little Red Riding Hood.”[3] Glenn Greenwald, the main journalist responsible for publication of the leaked material, is also in the crosshairs of the media, and has been accused of committing a felony for publishing the leaked material.[4] He has also been questioned by establishment media figures as to whether he should be charged with a crime for having “aided and abetted” Snowden.[5] This, of course, is preferable to a sack over the head and a bullet to the brain, but it is a far cry from creating an environment for openness and transparency in government conduct.

The entire story is here.

'Modern Slavery' in England Is a Prevalent Problem, Report Suggests

By Science Daily
Originally published on July 2, 2013

The first evidence of widespread 'modern slavery' in England for refugees and asylum seekers is revealed in a study published today.

The two-year study calls for an overhaul of government policy to restore asylum seekers' right to work and ensure all workers can access basic employment rights, such as National Minimum Wage, irrespective of immigration status.

Dr Stuart Hodkinson from the University of Leeds, who co-authored of the study, said: "We found that in the majority of cases, if the asylum seeker had been able to work legally then the employer or agent would not have been able to exploit and abuse them to such an appalling extent."

The entire story is here.

The original report can be found at the link below:
PRECARIOUS LIVES: Experiences of forced labour among refugees and asylum seekers in England

Monday, July 22, 2013

Models of Morality

By Molly J. Crockett
Wellcome Trust Centre for Neuroimaging

Moral dilemmas engender conflicts between two traditions: consequentialism, which evaluates actions based on their outcomes, and deontology, which evaluates the actions themselves.  These strikingly resemble two distinct decision-making architectures: a model-based system that selects actions based on inferences about their consequences; and a model-free system that selects actions based on their reinforcement history.  Here, I consider how these systems, along with a Pavlovian system that responds reflexively to rewards and punishments, can illuminate puzzles in moral psychology.

The entire article is here.

Thanks to Molly for making this journal article public.

50 Shades of Gray Matter

By Sally Satel
The Chronicle of Higher Education
Originally published July 9, 2013

You’ve seen the headlines: This is your brain on God, envy, cocaine. And you’ve seen the evidence: slices of brain with Technicolor splotches lit up like the Las Vegas Strip.

On average, one new book about the brain appears every week. In universities, new disciplines of neuroeconomics, neuroaesthetics, and neurolaw are flourishing. “If Warhol were around today, he’d have a series of silkscreens dedicated to the cortex; the amygdala would hang alongside Marilyn Monroe,” one observer quipped.

It is easy to see why the brain is a hot commodity. As the organ of the self, it makes sense to think that understanding how the brain works can help us understand ourselves, repair our flaws, and perfect our nature.

The entire blog post is here.

Sunday, July 21, 2013

Canadians see misconduct in workplace, but few are reported

By Theresa Tedesco
Financial Post
Originally published July 4, 2013

As many as 42% of working Canadians – or 7.1 million — say they have witnessed breaches of ethical conduct in their workplace and 48% of them did not report the misconduct, according to a new study on ethics in the Canadian workplace.

At the same time, a survey by Ipsos Reid revealed that one in three working Canadians felt that “delivering results in their organization was more important than doing the right thing.” Furthermore, 22% of respondents said they felt they had to compromise their personal ethics to keep their job.

The entire article is here.

UNC Faces Federal Investigation Into Retaliation Complaint By Sexual Assault Survivor

By Tyler Kingkade
The Huffington Post
Originally published July 7, 2013

The U.S. Department of Education's Office for Civil Rights is opening a new investigation into the University of North Carolina-Chapel Hill over allegations that UNC-Chapel Hill sophomore Landen Gambill faced retaliation for filing a federal complaint against the university. Gambill's case gained national attention after she reported a sexual assault to the school and was later charged with a school honor code violation.

(cut)

Gambill filed an additional complaint in March after being charged with the honor code violation by the student-run honor court. The court charged that Gambill created an "intimidating" environment for her alleged abuser, an ex-boyfriend and fellow Chapel Hill student whom she has never named publicly. Gambill would have faced expulsion if she had been found guilty, but the charge was eventually dropped.

The entire story is here.

Prior stores about this case can be found here and here.

Editor's Note: When this story was discussed at a recent ethics education workshop, participants were stunned that there was no other civil rights actions convened against UNC-Chapel Hill.  Obviously, the story has changed.


Saturday, July 20, 2013

Interview with Peter Singer-Part I

By Giving What We Can Cambridge  |  Posted June 18th, 2013

In early May, Peter Singer visited Cambridge to give a talk on effective altruism and Giving What We Can at the Cambridge Union. Before the talk, a team from Giving What We Can Cambridge took the opportunity to discuss effective altruism and effective careers with Professor Singer. In the first part of the interview, published below, Singer answers questions on giving and altruism.

Effective Altruism and some of the key questions behind it…

GWWC: How would you see the relationship between effectiveness and altruism? Where would you place an emphasis? Do you see them as being equally important?

Peter Singer: They are both important. I think really what I'm interested in is the impact that we end up having on problems that need to be dealt with, let's say particularly the issue of global poverty. So it's like saying: if what you're interested in is how much water you get into a bucket then it depends on how wide or narrow the stream is as well as the force, the pressure, with which the water is coming out. You want altruism because that will mean that people do more, but you want it to be effective because that will mean it will have a bigger impact.

GWWC: In a nutshell, what is wrong with the morality exhibited by most people, and what is your alternative?

Peter Singer: What is wrong with it is that people tend to look predominantly at what they actually do as determining right or wrong rather than what they omit to do. Very often when we allow things to happen that we could have prevented, the consequences might be much more serious than infractions to moral rules that people take quite seriously. So I think that our attitude towards morality, to what is involved in living well, is warped by too much of a distinction between acts and omissions.

The entire story is here.

Interview with Peter Singer-Part II

By Giving What We Can Cambridge  |  Posted June 27th, 2013

In early May, Peter Singer visited Cambridge to give a talk on effective altruism and Giving What We Can at the Cambridge Union. Before the talk, a team from Giving What We Can Cambridge took the opportunity to discuss effective altruism and effective careers with Professor Singer.

In the second part of the interview, published below, Singer answers questions on effective careers.

--

Applying effective altruism to career choices – the idea behind “effective careers”

GWWC: How would you define an effective career?

Peter Singer: An effective career is one in which you seek to make the biggest possible beneficial impact on the world. That would be the most effective career but not many people will reach this. What you see instead is people striving for the most effective career and changing their career choices in order to have a bigger impact, if not the biggest. Overall this is adding another dimension to what effective altruism is all about.

GWWC: Is there a set of stable criteria that identifies a career as effective or good? Or does it differ from person to person? Because ultimately it is very hard to anticipate what impact these big life choices will have. With all that in mind what advice would you give to university students and young people interested in making these decisions?

Peter Singer: The main advice is to think about your career as something you are going to spend a large amount of time and energy on – 80,000 hours – and therefore not just to fall into one career or the other but to make a conscious choice to end up in a career where you can make a significant difference, and expect to get some satisfaction and well-being from doing so. But that’s very general advice, I can’t give advice to students saying either you should become a doctor to go and help people abroad who need health-care, or you should become a scientist so that you can discover renewable energy that doesn’t emit greenhouse gases, or you should go into finance so that you can earn a lot of money and donate to these organisations. That decision is going to depend on the individual’s talent and character. Each individual has to think for himself or herself “what can I contribute and where can I have the greatest impact” and then commit to doing so.

The entire interview is here.

Friday, July 19, 2013

The Morality of Meditation

By David DeSteno
The New York Times - Gray Matter
Originally published July 5, 2013

Here is an excerpt:

Gaining competitive advantage on exams and increasing creativity in business weren’t of the utmost concern to Buddha and other early meditation teachers. As Buddha himself said, “I teach one thing and one only: that is, suffering and the end of suffering.” For Buddha, as for many modern spiritual leaders, the goal of meditation was as simple as that. The heightened control of the mind that meditation offers was supposed to help its practitioners see the world in a new and more compassionate way, allowing them to break free from the categorizations (us/them, self/other) that commonly divide people from one another.

But does meditation work as promised? Is its originally intended effect — the reduction of suffering — empirically demonstrable?

To put the question to the test, my lab, led in this work by the psychologist Paul Condon, joined with the neuroscientist Gaëlle Desbordes and the Buddhist lama Willa Miller to conduct an experiment whose publication is forthcoming in the journal Psychological Science.

The entire story is here.

PA Gay Marriage Ban Faces ACLU Challenge

By Chris Gentilviso
The Huffington Post
Originally published July 9, 2013

Two weeks after the Supreme Court ruled that a federal ban on same-sex marriage is unconstitutional, the American Civil Liberties Union is bringing that decision to the state level.

The Associated Press reported Tuesday that the group is filing a lawsuit against Pennsylvania's same-sex marriage ban. The move will also aim to keep state officials from mounting further challenges against same-sex couples seeking to marry.

The entire story is here.

Editorial note: I would never have imagined that folks in Pennsylvania would be this progressive.

Thursday, July 18, 2013

Cruel and Competitive or Compassionate and Cooperative?

Are We Born To Be Cruel and Competitive or Compassionate and Cooperative?

Samuel Knapp, EdD, ABPP
Director of Professional Affairs - Pennsylvania Psychological Association
The Pennsylvania Psychologist

What is the nature of humankind? Are we devils who only occasionally show sparks of morality? Or are we angels who sometimes slip into depravity? This question is not merely an interesting academic exercise. Instead, our assumptions about human nature, and our capacity for good or evil, help shape our expectations of each other and our expectations for ourselves. If we assume that humans are naturally evil and aggressive, we may tolerate or justify insensitive or cruel acts. On the other hand, if we assume that humans have a strong capacity for compassion and cooperation, then we may demand more of it from others and ourselves. [1]

Compassion and cooperation in non-human primates

Some claim that only the restraining force of civilization keeps people from “acting like animals.” Like the children in Lord of the Flies, it is argued that only a modest breakdown of external control can unleash the worst instincts of people that are lurking under a thin surface of civility. However, consider this event that occurred at the Brookfield zoo outside of Chicago on August 16, 1996:
A 3-year-old boy climbed the wall around the gorilla enclosure and fell 18 feet on to concrete into the enclosure, where he remained unconscious. Spectators gasped when the gorilla Binti Jua picked up the child, certain that the gorilla would harm him. However, Binti Jua gently cradled the infant with her right arm and carried him to an access entrance where the zoo keeper was waiting to take the child. Her own baby, Koola clutched her back during the entire incident. (Jones, 2011). 
Primatologist Frans deWaal (2010) could cite this and many other less dramatic incidents to illustrate the complexity of behavior of non-human primates, including their capacity for prosocial behaviors. DeWaal is no sentimentalist. He knows that some primates, such as chimpanzees, can act with great brutality such as when they engage in lethal gang warfare against members of their own species. Nonetheless, he claims that non-human primates also show love, compassion, and social cooperation. It is simply scientifically inaccurate, he argues, to conclude that our biological heritage necessarily drives us toward cruelty and selfishness. On the contrary, empathy and cooperation, deWaal claims, may be an equal or even greater part of our biological nature than callousness and aggression.

Detailed observations of non-human primates support deWaal’s conclusions. Primatologist Barbara Smuts states that “life in African ape societies possesses all the essential ingredients of first-rate soap operas; convoluted plots, passion, lots of sex and politics, surprise endings, and a cast of distinct characters” (2000, p. 80). Non-human primates rely heavily on their social networks and have a detailed mental record keeping system of who has helped them in the past and to whom they owe obligations. They know their kin and they gravitate toward them. Children will remember their mothers; mothers appear depressed at the death of their children. Chimpanzees keep track of who groomed them this morning when they share food in the afternoon, and they support their friends during fights. When endangered they will cling to each other or hold hands. Friendships can last a life time.
Here are some examples of social cooperation:
Rachael, a monkey raised in the wild and later captured, raised orphaned children as her own (Smith, 2005).
A bonobo inserted herself between a poisonous snake and her friend at the risk of her own life (deWaal, 2011).
A high-ranking chimpanzee ensures that all members of his social group, even lower ranking members, get something to eat from his kill (deWaal, 2011). 
Cooperation and a sense of fairness even show up in controlled experiments. For example, monkeys are quite happy to receive a cucumber from experimenters, unless they see a companion getting a much more valued grape, whereupon they may reject the cucumber (deWaal, 2011).

Compassion and cooperation in human primates 

What evidence is there that these findings would generalize to human behavior? Are human primates as motivated by fairness as their non-human cousins? One source of information about human fairness and compassion comes from studies of game theory. Every fan of television crime shows has seen a version of the “prisoner’s dilemma” in which two people are arrested for a crime and are interrogated separately. Each prisoner knows that if they confess to the crime and implicate their partner, they will get a light sentence and their partner will get a heavy sentence (and conversely if their partner in crime confesses, they will get a heavy sentence, and their partner will get a light sentence), but if both prisoners refuse to talk, it is possible that neither of them will get any sentence at all.

Game theory, developed by behavioral economists, refers to simulations that are often modeled loosely on the prisoner’s dilemma. That is, in these situations participants can either gain or lose according to the degree of cooperation between them. Consider the Ultimatum Game:
Players are given a certain amount of money (for example $10) and put in separate rooms. Player one gets to decide how the money is to be split between him or her and player two. Player one could give it all away, keep it all, or give a share to player two. Then player two gets to decide whether to accept or reject the offer. If player two accepts the offer, then the offer is in effect. If player two rejects the offer, then no one gets anything. 
When Americans play the Ultimatum Game, offers of $2 were rejected half the time, but offers lower than $2 were rejected even more commonly. These findings run contrary to traditional economic theory that says that people should be motivated primarily be rational self-interest and player two should accept the offer of any money, because something is better than nothing.

However, consider the outcomes with a second type of game, The Dictator Game:
Player one is given a certain amount of money (for example $10) and is put in a room separate from player two. Player one gets to decide how much money to offer to player two. There is no opportunity to accept or reject: player two has to accept what is offered. 
When the Dictator Game is actually played, the amount most often offered by player one was 20% to 30% of the original amount, although the most common offers were nothing or one-half. That is, player one usually gave something to player two, and frequently gave player two the same amount that he/she took for him/herself. Traditional economic theory would predict that player one should offer player two nothing, since all players should be motivated primarily by their own financial interests.

Over the years behavioral economists have replicated or varied these games in hundreds of experiments. They have learned, for example, that in both the Dictator Game and the Ultimatum Game, several factors can influence the degree of cooperation including whether or not the players are anonymous, come from cultures where trading or commerce is common, or (in round robin games) previous participants were generous to them.

Just like the monkeys who reject the cucumber when it seems that they were being treated unfairly, players will often reject offers in the Ultimatum Game that they consider to be unfair. Like the monkeys, they would rather get nothing than submit to an unfair system. Just like the monkeys, baboons, and chimpanzees who feel social obligations to their relatives and friends, players in the Ultimatum and Dictator Games will be more generous with friends and relatives than with strangers, and will be more generous to those who have been generous to them in the past. Although we cannot automatically extrapolate every finding from the study of the behavior of non-human primates or game theory to other contexts, these sources of data suggest that humans are not motivated exclusively by short-term self-interest, but that fairness and cooperation also help drive human behavior.

References
deWaal, F. B. M. (2005, April). How animals do business. Scientific American, 292, 72-79.
deWaal, F. B. M. (2011). The age of empathy. New York: Harmony Books.
Kish-Gephart, J. J., Harrison, D. A., & Treviño, L. K. (2010). Bad apples, bad cases, or bad barrels: A meta-analytic evaluation about sources of unethical behavior at work. Journal of Applied Psychology, 95, 1-31.
Jones, J. (2011, August 16). From the archives: Gorilla saves boy. Retrieved from http://www.nbcchicago.com/news/local/binji-jua-127910608.html
Smuts, B. (2000, December). Common ground. Natural History, 78-83.

Smith, H. J. (2005). Parenting for primates. Cambridge, MA: Harvard University Press.

[1] Philosophers such as Thomas Hobbes and Niccolò Machiavelli expected the worst from others. But in their review of unethical behavior in business organizations, Kish-Gephart et al. (2010) found that those who had a Machiavellian interpretation of human behavior were more likely to engage in unethical behavior. 

When states monitored their citizens we used to call them authoritarian. Now we think this is what keeps us safe

By Susan Moore
The Guardian - Comments
Originally published July 3, 2013

Here is an excerpt:

What I failed to grasp, though, was quite how much I had already surrendered my liberty, not just personally but my political ideals about what liberty means. I simply took for granted that everyone can see everything and laughed at the idea that Obama will be looking at my pictures of a cat dressed as a lobster. I was resigned to the fact that some random FBI merchant will wonder at the inane and profane nature of my drunken tweets.

Slowly but surely, The Lives of Others have become ours. CCTV cameras everywhere watch us, so we no longer watch out for each other. Public space is controlled. Of course, much CCTV footage is never seen and often useless. But we don't need the panopticon once we have built one in our own minds. We are all suspects.

Or at least consumers. iTunes thinks I might like Bowie; Amazon thinks I want a compact tumble dryer. Really? Facebook seems to think I want to date men in uniform. I revel in the fact that the algorithms get it as wrong as the man who knocks on my door selling fish out of a van. "And not just fish," as he sometimes says mysteriously.

The entire comment is here.

Wednesday, July 17, 2013

First major study of suicide motivations to advance prevention

Media Release
The University of British Columbia
Originally posted on June 13, 2013

Published in the official journal of the American Association of Suicidology, the work gives doctors and researchers important new resources to advance suicide prevention, improve treatments, and reduce the likelihood of further attempts.

“Knowing why someone attempted suicide is crucial – it tells us how to best help them recover,” says Prof. David Klonsky, UBC Dept. of Psychology. “This new tool will help us to move beyond the current “one-size-fits-all” approach to suicide prevention, which is essential. Different motivations require different treatments and interventions.”

(cut)

The study also finds that suicide attempts influenced by social factors – such as efforts to elicit help or influence others – generally exhibited a less pronounced intent to die, and were carried out with a greater chance of rescue. In contrast, suicide attempts motivated by internal factors – such as hopelessness and unbearable pain – were performed with the greatest desire to die.

“It may be surprising to some, but focusing on motivations is a new approach in the field of suicide research – and urgently needed,” says Klonsky. “Until now, the focus has been largely on the types of people attempting suicide – their demographics, their genetics – without actually exploring the motivations. Ours is the first work to do this in a comprehensive and systematic way.”

The entire media release is here.

The Suicide Detective

By KIM TINGLEY
The New York Times
Published: June 26, 2013

Here are some excerpts:

Despite the progress made by science, medicine and mental-health care in the 20th century — the sequencing of our genome, the advent of antidepressants, the reconsidering of asylums and lobotomies — nothing has been able to drive down the suicide rate in the general population. In the United States, it has held relatively steady since 1942. Worldwide, roughly one million people kill themselves every year. Last year, more active-duty U.S. soldiers killed themselves than died in combat; their suicide rate has been rising since 2004. Last month, the Centers for Disease Control and Prevention announced that the suicide rate among middle-aged Americans has climbed nearly 30 percent since 1999.

(cut)

Trying to study what people are thinking before they try to kill themselves is like trying to examine a shadow with a flashlight: the minute you spotlight it, it disappears. Researchers can’t ethically induce suicidal thinking in the lab and watch it develop. Uniquely human, it can’t be observed in other species. And it is impossible to interview anyone who has died by suicide. To understand it, psychologists have most often employed two frustratingly imprecise methods: they have investigated the lives of people who have killed themselves, and any notes that may have been left behind, looking for clues to what their thinking might have been, or they have asked people who have attempted suicide to describe their thought processes — though their mental states may differ from those of people whose attempts were lethal and their recollections may be incomplete or inaccurate. Such investigative methods can generate useful statistics and hypotheses about how a suicidal impulse might start and how it travels from thought to action, but that’s not the same as objective evidence about how it unfolds in real time.

The entire story is here.

Tuesday, July 16, 2013

Sharp Rise in Drug Overdoses Among U.S. Women: CDC

By Steven Reinberg
MedicineNet.com
Originally posted July 2, 2013

The rate of fatal overdoses of prescription painkillers and other drugs among U.S. women quadrupled between 1999 and 2010, federal officials reported Tuesday.

Long thought of as primarily a male problem, drug addiction is increasingly affecting women, and the new study from the Centers for Disease Control and Prevention estimates that 42 women in the United States die each day from prescription drug overdoses.

"Prescription drug overdose deaths have skyrocketed in women," CDC Director Dr. Thomas Frieden said during a noon press conference. "Mothers, wives, sisters and daughters are dying from overdoses at rates we have never seen before."

(cut)

Other statistics, based on 2010 data:

  • Suicides from these drugs accounted for 34 percent of all suicides among women, compared with 8 percent among men.
  • More than 940,000 women were seen in emergency departments for drug misuse or abuse.
  • More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose.
  • Narcotic painkillers accounted for four times more deaths among women than deaths linked to cocaine and heroin combined.
  • More than 200,000 emergency department visits were for misuse or abuse of these drugs among women -- about one every three minutes.

The entire story is here.

Prisons and the Mentally Ill

Religion and Ethics Newsweekly
Originally published June 21, 2013

It doesn’t make moral, ethical, or fiscal sense, according to Cook County sheriff Tom Dart, to house people who are mentally ill in jails and prisons.



Monday, July 15, 2013

Moral Luck

By Thomas Nagel

Here is an excerpt:

Where a significant aspect of what someone does depends on factors beyond his control, yet we continue to treat him in that respect as an object of moral judgment, it can be called moral luck. Such luck can be good or bad. And the problem posed by this phenomenon, which led Kant to deny its possibility, is that the broad range of external influences here identified seems on close examination to undermine moral assessment as surely as does the narrower range of familiar excusing conditions. If the condition of control is consistently applied, it threatens to erode most of the moral assessments we find it natural to make. The things for which people are morally judged are determined in more ways than we at first realize by what is beyond their control. And when the seemingly natural requirement of fault or responsibility is applied in light of these facts, it leaves few pre-reflective moral judgments intact.  Ultimately, nothing or almost nothing about what a person does seem to be under his control.

Why not conclude, then, that the condition of control is false--that it is an initially plausible hypothesis refuted by clear counter-examples? One could in that case look instead for a more refined condition which picked out the kinds of lack of control that really undermine certain moral judgments, without yielding the unacceptable conclusion derived from the broader condition, that most or all ordinary moral judgments are illegitimate.

What rules out this escape is that we are dealing not with a theoretical conjecture but with a philosophical problem. The condition of control does not suggest itself merely as a generalization from certain clear cases. It seems correct in the further cases to which it is extended beyond the original set.  When we undermine moral assessment by considering new ways in which control is absent, we are not just discovering what would follow given the general hypothesis, but are actually being persuaded that in itself the absence of control is relevant in these cases too. The erosion of moral judgment emerges not as the absurd consequence of an over-simple theory, but as a natural consequence of the ordinary idea of moral assessment, when it is applied in view of a more complete and precise account of the facts. It would therefore be a mistake to argue from the unacceptability of the conclusions to the need for a different account of the conditions of moral responsibility. The view that moral luck is paradoxical is not a mistake, ethical or logical, but a perception of one of the ways in which the intuitively acceptable conditions of moral judgment threaten to undermine it all.

The entire article is here.

The Half-Trillion-Dollar Depression

By CATHERINE RAMPELL
The New York Times
Published: July 2, 2013

Mental illness has been an increasingly significant health concern over the past several decades, but it’s now becoming an economic one too. The number of Americans who receive Social Security Disability Insurance for mental disorders has doubled during the past 15 years. Eliza is now one of an estimated 11.5 million American adults with a debilitating mental illness, on whom the country spends about $150 billion annually on direct medical costs — therapy, drugs, hospitalizations and so forth. But the biggest blow to the overall economy are the many hidden, indirect costs. People with serious mental illness earn, on average, $16,000 less than their mentally well counterparts, totaling about $193 billion annually in lost earnings, according to a 2008 study published in The American Journal of Psychiatry. And many mentally ill workers, who are more likely to miss work, also suffer from what social scientists call presenteeism — the opposite of absenteeism — in which they are very likely to be less productive on the job when they show up.

(cut)

Even though tens of millions of people will get more coverage, estimates suggest that only 1.15 million new users will take advantage of mental-health services. A lot of people who will be extended coverage don’t need care; others, fearful of the stigma around mental health, may not take it. What’s more distressing, from both an economic and a social perspective, is that a lot of people who do muster the courage still won’t get the right kind of treatment. About half of Americans who seek care for serious mental illnesses get treatment that does not help them or is not even recommended for their condition.

The entire article is here.

Sunday, July 14, 2013

Corruption in Business and the Importance of Ethics

By Vivek Wadhwa
The Wall Street Journal Blog - The Accelerators
Originally published June 28, 2013

Here is an excerpt:

How can companies do better? Corporate executives and business owners need to realize that there can be no compromise when it comes to ethics and there are no easy shortcuts to success. Ethics need to be carefully sown into the fabric of their companies.

Business executives need to start by spelling out and communicating their values. Then they need to lead by example. This means getting rid of the bad apples and declining opportunities that bring instant wealth at the cost of selling one’s soul.

Corporate culture is built from the top down. Employees embrace the ethics and values of their leaders. You simply can’t have one set of standards for management and another for staff. Every executive and employee needs to be held accountable.

Employees need to be encouraged to speak up when they see wrongdoing — to “speak truth to power.” And when a mistake is made, it is better to deal with the immediate fallout rather than allow it to build its own momentum. A corporate culture that doesn’t allow for mistakes is destined for disaster. The best strategy is to encourage employees to come clean and learn from their errors.

The worst is when employees are pressured to hide information. A company can usually survive short term snags. But covering up a problem is likely to create even bigger problems later on.  No truth remains hidden forever.

The entire article is here.

New whistleblower protections take effect for federal contractors

By Jared Serbu
Federal News Radio
Originally published July 1, 2013

Effective Monday, whistleblower protections for federal contractors are being expanded to fill gaps that whistleblower advocates say have, until now, left tens of thousands of potential witnesses to wrongdoing vulnerable to retaliation by their employers.

Under any federal contract that's signed on or after July 1, reprisal protections will be extended for the first time to subcontractors who report waste, fraud or abuse.

The revision to federal statutes also entitles contractor employees to whistleblower protection when they report wrongdoing on a federal contract to supervisors within their own companies. Previous laws required them to take their complaints to a government office such as an inspector general, a government contract manager or a member of Congress in order to receive protection.

The entire article is here.

Saturday, July 13, 2013

Avoiding the digital ‘flock’

By Chuck Leddy,
Harvard Gazette
Originally published June 27, 2013

Here are two excerpts:

Digital tools actually encourage flocking (called “homophily” by social scientists), Zuckerman said. For instance, “Facebook is very good at connecting us with people we’re already connected with.”  Zuckerman also mentioned Facebook’s search function, which personalizes results based on your “likes” and the preferences of your friends. “It’s kind of creepy,” said Zuckerman. “I’m not sure I want my friends pre-filtering for me.”

Whether in the real or virtual worlds, said Zuckerman, “We have a talent for finding people with the same socioeconomic background or racial background. But this tendency to flock may be keeping us from finding the information we need,” and the tools we’ve built for the Internet only enhance our flocking bias.

“My fear is that our tools are not promoting diversity,” said Zuckerman, whose appearance served as a launch party for his book “Rewire.” Personalization tools “want to give you precisely what you want, to make you comfortable” and ready to buy things, he said. “The danger is that we may be driven into small circles of the same content,” a sort of digital self-segregation into echo chambers where none of our assumptions get scrutinized.

(cut)

How then should people manage their tendency to seek out like-minded folk? First, they need to track their behavior for the presence of flocking bias. Zuckerman showed a graph exposing his own Twitter “follow bias”: Only 27 percent of the people he follows are women. “This is an embarrassing slide,” Zuckerman said, “but now when I follow someone, I think about” the follow bias. He said people need to be self-reflective about their media-consumption preferences, and push back against them. “I know that left on my own, I’d spend all my time reading cute cat macros on Reddit” or constantly consuming news about his beloved Green Bay Packers.

The entire story is here.

Breaking the Seal on Drug Research

By KATIE THOMAS
The New York Times
Published: June 29, 2013

Here are som excerpts:

For years, researchers have talked about the problem of publication bias, or selectively publishing results of trials. Concern about such bias gathered force in the 1990s and early 2000s, when researchers documented how, time and again, positive results were published while negative ones were not. Taken together, studies have shown that results of only about half of clinical trials make their way into medical journals.

Problems with data about high-profile drugs have led to scandals over the past decade, like one involving contentions that the number of heart attacks was underreported in research about the painkiller Vioxx. Another involved accusations of misleading data about links between the antidepressant Paxil and the risk of suicide among teenagers.

To those who have followed this issue for years, the moves toward openness are unfolding with surprising speed.

“This problem has been very well documented for at least three decades now in medicine, with no substantive fix,” said Dr. Ben Goldacre, a British author and an ally of Dr. Doshi. “Things have changed almost unimaginably fast over the past six months.”

Much of that change is happening because of what Dr. Goldacre calls an “accident of history.” In 2009, Dr. Doshi and his colleagues set out to answer a simple question about the anti-flu drug Tamiflu: Does it work? Resolving that question has been far harder than they ever envisioned, and, four years later, there is still no definitive answer. But the quest to determine Tamiflu’s efficacy transformed Dr. Doshi and others into activists for transparency — and turned the tables on drug makers. Until recently, the idea that companies should routinely hand over detailed data about their clinical trials might have sounded far-fetched. Now, the onus is on the industry to explain why it shouldn’t.

(cut)

Earlier this month, Dr. Doshi opened what he hopes will be a new chapter in his quest for greater understanding of clinical trials. He and several other researchers published what amounted to an ultimatum to drug companies: publish your data, or we’ll do it for you.

The entire story is here.

Friday, July 12, 2013

ATA Responds to CMS Proposal for Expanded Telemedicine Coverage

Press Release
The American Telemedicine Association
Originally published July 10, 2013

The American Telemedicine Association voices its cautious support for new proposals by the Centers for Medicare and Medicaid Services (CMS) that would expand Medicare’s telehealth footprint.  CMS proposes to increase the number of beneficiaries eligible for telemedicine by modifying their urban/rural definitions and proposes several new reimbursable telemedicine services.

“Overall, the proposed rules are good news for Medicare patients and forward-thinking healthcare providers. We applaud CMS for taking steps to help these patients benefit from proven telemedicine technologies,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association. "But many potential beneficiaries are still left behind.  For example, we hope that either CMS or Congress take additional steps to restore telehealth benefits to the one million beneficiaries in 104 counties that lost coverage last year due to reclassification to metropolitan areas.”

The entire story is here.

Thanks to Alex Siegel for this information

Diagnosis: Insufficient Outrage

By H. GILBERT WELCH
The New York Times - Op Ed
Published: July 4, 2013

RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?

I’m not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although crime in that sense definitely exists. I’m talking instead about the violation of an ethical standard, of the very “calling” of medicine.

Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting.

A number of publications — including this one — have recently published big reports on the exorbitant cost of American health care. In March, Time magazine ran a cover story exposing outrageous hospital prices, from $108 for a tube of bacitracin — the ointment my mother put on the scrapes I got as a kid and that costs $5 at CVS — to $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.

The entire story is here.

Kill Whitey. It’s the Right Thing to Do.

by David Dobbs
Neuron Culture
September 15, 2010

Here is an excerpt:

Researchers generally use these (trolley) scenarios to see whether people hold a) an absolutist or so-called “deontological” moral code or b) a utilitarian or “consequentialist” moral code. In an absolutist code, an act’s morality virtually never depends on context or secondary consequences. A utilitarian code allows that an act’s morality can depend on context and secondary consequences, such as whether taking one life can save two or three or a thousand.

In most studies, people start out insisting they have absolute codes. But when researchers tweak the settings, many people decide morality is relative after all: Propose, for instance, that the fat man is known to be dying, or was contemplating jumping off the bridge anyway — and the passengers are all children — and for some people, that makes it different. Or the guy is a murderer and the passengers nuns. In other scenarios the man might be slipping, and will fall and die if you don’t grab him: Do you save him … even if it means all those kids will die? By tweaking these settings, researchers can squeeze an absolutist pretty hard, but they usually find a mix of absolutists and consequentialists.

As a grad student, Pizarro liked trolleyology. Yet it struck him that these studies, in their targeting of an absolutist versus consequentialist spectrum, seemed to assume that most people would hold firm to their particular spots on that spectrum — that individuals generally held a roughly consistent moral compass. The compass needle might wobble, but it would generally point in the same direction.

Pizarro wasn’t so sure. He suspected we might be more fickle. That perhaps we act first and scramble for morality afterward, or something along those lines, and that we choose our rule set according to how well it fits our desires.

The entire blog post is here.

Thursday, July 11, 2013

WellPoint to pay $1.7 million HIPAA penalty

By Rachel Landen and Joseph Conn
ModernHealthcare.com
Published July 11, 2013

WellPoint, which serves nearly 36 million people through its affiliated health plans, has agreed to pay a $1.7 million penalty to HHS for potential violations of the privacy and security rules under the Health Insurance Portability and Accountability Act of 1996.

Between Oct. 23, 2009, and March 7, 2010, access to personal data for 612,402 people—their names, dates of birth, addresses, Social Security numbers, telephone numbers and health information—was made available to unauthorized users as the result of online security weaknesses, HHS said Thursday.

During an investigation of WellPoint's information systems, HHS' Office for Civil Rights found that the Indianapolis-based insurer had not enacted appropriate administrative, technical and physical safeguards for data as required by HIPAA.

The entire story is here.

Medicare fraud outrunning enforcement efforts

By Fred Shulte
The Center for Public Integrity
Originally published on July 1, 2013

Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse — even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration.

The Department of Health and Human Services Office of Inspector General is set to lose a total of 400 staffers that are deployed nationwide as a primary defense against health care fraud and abuse. Though agency officials have yet to decide which investigations will be shelved as staff dwindles, the existing staff is already stretched so thin that the agency has failed to act on 1,200 complaints over the past year alleging wrongdoing — and expects that number to rise. The OIG began shedding staff at the beginning of the year.

The budget crunch surfaced during questioning at a June 24 hearing of the Senate Committee on Homeland Security and Governmental Affairs. The hearing was called to examine prescription drug abuse in Medicare.

Gary Cantrell, Deputy Inspector General for the OIG Office of Investigations, said at the hearing that his unit “is shrinking” even as the federal Medicare and Medicaid programs grow in size and complexity. “We’re set to lose roughly 400 bodies out of a total of 1,800 at our peak in 2012. That’s really limiting our ability to expand our oversight in some of these areas,” he said.

Stuart Wright, Deputy Inspector General for the OIG Office of Evaluations and Inspections, added that 200 of those staffers will have departed by the end of this year and 200 more are out the door by the end of 2015.

The entire story is here.

Privacy and the Threat to the Self

By MICHAEL P. LYNCH
The New York Times - Opinionator
Originally published June 22, 2013

In the wake of continuing revelations of government spying programs and the recent Supreme Court ruling on DNA collection – both of which push the generally accepted boundaries against state intrusion on the person — the issue of privacy is foremost on the public mind. The frequent mantra, heard from both media commentators and government officials, is that we face a “trade-off” between safety and convenience on one hand and privacy on the other. We just need, we are told, to find the right balance.

This way of framing the issue makes sense if you understand privacy solely as a political or legal concept. And its political importance is certainly part of what makes privacy so important: what is private is what is yours alone to control, without interference from others or the state. But the concept of privacy also matters for another, deeper reason. It is intimately connected to what it is to be an autonomous person.

What makes your thoughts your thoughts? One answer is that you have what philosophers sometimes call “privileged access” to them. This means at least two things. First, you access them in a way I can’t. Even if I could walk a mile in your shoes, I can’t know what you feel in the same way you can: you see it from the inside so to speak. Second, you can, at least sometimes, control what I know about your thoughts. You can hide your true feelings from me, or let me have the key to your heart.

The entire story is here.

Wednesday, July 10, 2013

How Reading Makes Us More Human

A debate has erupted over whether reading fiction makes human beings more moral. But what if its real value consists in something even more fundamental?

By Karen Swallow Prior
The Atlantic
Originally posted on June 21, 2013

A battle over books has erupted recently on the pages of The New York Times and Time. The opening salvo was Gregory Currie's essay, "Does Great Literature Make Us Better?" which asserts that the widely held belief that reading makes us more moral has little support. In response, Annie Murphy Paul weighed in with "Reading Literature Makes Us Smarter and Nicer." Her argument is that "deep reading," the kind of reading great literature requires, is a distinctive cognitive activity that contributes to our ability to empathize with others; it therefore can, in fact, makes us "smarter and nicer," among other things. Yet these essays aren't so much coming to different conclusions as considering different questions.

To advance her thesis, Paul cites studies by Raymond Mar, a psychologist at York University in Canada, and Keith Oatley, a professor emeritus of cognitive psychology at the University of Toronto. Taken together, their findings suggest that those "who often read fiction appear to be better able to understand other people, empathize with them and view the world from their perspective." It's the kind of thing writer Joyce Carol Oates is talking about when she says, "Reading is the sole means by which we slip, involuntarily, often helplessly, into another's skin, another's voice, another's soul."

Oatley and Mar's conclusions are supported, Paul argues, by recent studies in neuroscience, psychology, and cognitive science. This research shows that "deep reading -- slow, immersive, rich in sensory detail and emotional and moral complexity -- is a distinctive experience," a kind of reading that differs in kind and quality from "the mere decoding of words" that constitutes a good deal of what passes for reading today, particularly for too many of our students in too many of our schools (as I have previously written about here).

Paul concludes her essay with a reference to the literary critic Frank Kermode, who famously distinguishes between "carnal reading" -- characterized by the hurried, utilitarian information processing that constitutes the bulk of our daily reading diet -- and "spiritual reading," reading done with focused attention for pleasure, reflection, analysis, and growth. It is in this distinction that we find the real difference between the warring factions in what might be a chicken-or-egg scenario: Does great literature make people better, or are good people drawn to reading great literature?

The entire article is here.

Three Shocking Truths About Lying At Work

By Keld Jensen
Forbes
Originally published June 24, 2013

Mark Twain famously said, “If you tell the truth, you don’t have to remember anything.” However, the benefit of a guilt-free conscious and a crystal-clear mind appears not to be a strong enough incentive to deter lying, especially in the workplace.

The pandemic of lying does not just refer to high-profile cases, such as Bill Clinton’s affair, Lance Armstrong’s denial of doping, and Bernie Madoff’s financial deceit. Workplace lying is a far more widespread issue and it is taking place in offices around the world. There is a steady undercurrent of dishonesty, “white lies,” cheating, and bending the rules, and it’s time we pull the rug out and expose three simple truths about lying.

1) You lie at work—so does everyone else. 

Most of us are willing to confess to it. According to a survey by psychotherapist and consultant Dr. Brad Blanton, 93% of respondents out of forty thousand Americans admitted to lying “regularly and habitually in the workplace.” Personally, I believe the other 7% are lying to themselves—and they probably believe it!

The entire story is here.

Tuesday, July 9, 2013

Person as Scientist, Person as Moralist

By Joshua Knobe
Upcoming in Brain and Brain Sciences

Abstract

It has often been suggested that people’s ordinary capacities for folk psychology and causal cognition make use of much the same methods one might find in a formal scientific investigation. A series of recent experimental results offer a challenge to this widely-held view, suggesting that people’s moral judgments can influence the intuitions they hold both in folk psychology and in moral cognition. The present target article argues that these effects are best explained on a model according to which moral considerations actually figure in the fundamental competencies people use to make sense of the world.

-----------

Consider the way research is conducted in a typical modern university. There are departments for theology, drama, philosophy… and then there are departments specifically devoted to the practice of science. Faculty members in these science departments generally have quite specific responsibilities. They are not supposed to make use of all the various methods and approaches one finds in other parts of the university.

Now consider the way the human mind ordinarily makes sense of the world. One plausible view would be that the human mind works something like a modern university.   There are psychological processes devoted to religion (the mind’s theology department), to aesthetics (the mind’s art department), to morality (the mind’s philosophy department) … and then there are processes specifically devoted to questions that have a roughly ‘scientific’ character. These processes work quite differently from the ones we use in thinking about, say, moral or aesthetic questions. They proceed using more or less the
same sorts of methods we find in university science departments.

This metaphor is a powerful one, and it has shaped research programs in many different areas of cognitive science. Take the study of folk psychology. Ordinary people have a capacity to ascribe mental states (beliefs, desires, etc.), and researchers have sometimes suggested that people acquire this capacity in much the same way that scientists develop theoretical frameworks (e.g., Gopnik & Wellman 1992). Or take causal cognition. Ordinary people have an ability to determine whether one event caused another, and it has been suggested that they do so by looking at the same sorts of statistical information scientists normally consult (e.g., Kelley 1967). Numerous other fields have taken a similar path. In each case, the basic strategy is to look at the methods used by professional research scientists and then to hypothesize that people actually use similar methods in their ordinary understanding. This strategy has clearly led to many important advances.

The entire article is here.

Morality study finds conservatives show a ‘general insensitivity to consequences’

By Eric W. Dolan
The Raw Story
Originally published Sunday, June 23, 2013

When it comes to topics like abortion or assisted suicide, there seems to be no common ground between conservatives and liberals. Why is there such a noticeable rift between the two political orientations?

Research published June in Social Psychological and Personality Science suggests that religious individuals and political conservatives think about moral issues in a fundamentally different way than liberals.

The study by Jared Piazza of the University of Pennsylvania and Paulo Sousa of Queen’s University Belfast, which included a total of 688 participants, found religious individuals and political conservatives consistently invoked deontological ethics. In other words, they judged the morality of actions based on a universal rule such as, “You should not kill.” Political liberals, on the other hand, consistently invoked consequentialist ethics, meaning they judged the morality of actions based on their positive or negative outcomes.

“Does being religious or being conservative promote a rule-based ethic or does having a rule-based ethic promote religiosity and/or conservatism?” Piazza told PsyPost. “This question is difficult to answer definitively without running a longitudinal study, since you cannot really manipulate religious orientation, or being in possession of a deontological orientation, and then look at the consequences.”

The study’s cross-sectional methodology makes it impossible to say anything more than religion and conservativism are associated with deontological ethics. However, Piazza said prior research suggested that being religious underlies the adherence to deontological ethics,

The entire story is here.

Monday, July 8, 2013

Vignette 27: To Skate or Not to Skate


Dr. Logan Earthski works with adolescents and their families.  During the course of treating one adolescent male, the parents, Mr. and Mrs. Hawk, expressed frustration with their son Tony’s lack of involvement with sports.  The Hawks detailed how Tony enjoyed team sports in the past, but has not enjoyed participating due to anxiety and constantly comparing himself to others.

In order to bond and connect with the family, Dr. Earthski explained from his experience with teens, some male teens function better with individual sports.  Dr. Earthski disclosed that he grew up skateboarding and taught lessons for several years.  A few of the children and adolescents he taught fit the description of Tony.  In those cases, the adolescent tried soccer or baseball, but did not really like it because they felt too anxious and overly competitive. 

When it came to individual sports, like skateboarding, teens that became involved with individual sports usually showed a decrease in anxiety and an increase in self-confidence.  However, sometimes, when adolescents first show up at the skate park, they may experience a similar level of anxiety and heightened self-awareness that Dr. Earthski helped remediate during his coaching sessions. 

Dr. Earthski also revealed that he worked with one particular teenager who became very anxious and experienced episodes of panic related to going to the skate park.  That adolescent did not think he was good and was weary of other kids watching and judging him.  Dr. Earthski gave him some coaching on anxiety reduction techniques and worked through those negative, anxiety-provoking emotions.  Further, he did very well at skateboarding once he conquered his symptoms of anxiety and panic.  The teenager's self-confidence grew as he performed better at the skate park.  Based on Dr. Earthski's revelations, the parents seemed reassured.

Prior to the next session, Dr. Earthski received a voicemail message from Mrs. Hawk asking if he could coach Tony on skate boarding.

After thinking about this request, Dr. Earthski calls you for a consult.  Dr. Earthski puts forward the following concerns:

1.  Is coaching a teenager-patient on anxiety-related issues in context of a skate boarding lessons definitively a dual relationship?

2.  What if the coaching is time-limited, informed consent is given, and this activity is viewed as the exception rather than the rule?  (“Time-limited” means between one and six sessions, depending on his response to treatment.)

3.  Can time-limited skateboard coaching be incorporated as part of an in-vivo anxiety reduction technique and billed as therapy services?

4.  Would Dr. Earthski’s malpractice insurance likely cover this activity?

5.  What would happen if the teen-patient injured himself as part of coaching?

6.  Dr. Earthski asks about the use of self-disclosure.  What feedback might you give to Dr. Earthski about what he disclosed about himself?

7.  Given everything you know about the case, what is/are the final recommendation(s) about this scenario?