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

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

Monday, September 30, 2013

Moral Psychology Is Relationship Regulation: Moral Motives for Unity, Hierarchy, Equality, and Proportionality

By Tage Shakti Rai and Alan Page Fiske
Psychological Review
2011, Vol. 118, No. 1, 57–75

Abstract

Genuine moral disagreement exists and is widespread. To understand such disagreement, we must examine the basic kinds of social relationships people construct across cultures and the distinct moral obligations and prohibitions these relationships entail. We extend relational models theory (Fiske, 1991) to identify 4 fundamental and distinct moral motives. Unity is the motive to care for and support the integrity of in-groups by avoiding or eliminating threats of contamination and providing aid and protection based on need or empathic compassion. Hierarchy is the motive to respect rank in social groups where superiors are entitled to deference and respect but must also lead, guide, direct, and protect subordinates. Equality is the motive for balanced, in-kind reciprocity, equal treatment, equal say, and equal opportunity. Proportionality is the motive for rewards and punishments to be proportionate to merit, benefits to be calibrated to contributions, and judgments to be based on a utilitarian calculus of costs and benefits. The 4 moral motives are universal, but cultures, ideologies, and individuals differ in where they activate these motives and how they implement them. Unlike existing theories (Haidt, 2007; Hauser, 2006; Turiel, 1983), relationship regulation theory predicts that any action, including violence, unequal treatment, and “impure” acts, may be perceived as morally correct depending on the moral motive employed and how the relevant social relationship is construed. This approach facilitates clearer
understanding of moral perspectives we disagree with and provides a template for how to influence moral motives and practices in the world.

The entire article is here.

‘Everyday Sadists’ Among Us

By Jan Hoffman
The New York Times
Originally published September 16, 2013

Here is an excerpt:

Those who enjoy inflicting at least moderate pain on others, directly or vicariously, mingle with us daily. Think mean girls, taunting a classmate to commit suicide. Or the professor who grills a squirming, clueless student, lips curled in a small, savage smile.

Delroy L. Paulhus, a psychology professor at the University of British Columbia, calls such people “everyday sadists.”

“They exist on a spectrum,” he said. “It could be at a hockey game and your guy is pummeling the opponent into hamburger and people are standing up having orgasms, to taking revenge on those you think deserve it, to schadenfreude.”

But acknowledging that sadists regularly cross our paths is unsettling, said Scott O. Lilienfeld, a professor of psychology at Emory University, who studies personality disorders. “We prefer to think, ‘There’s sadists, and then there’s the rest of us.’ ”

The entire story is here.

Sunday, September 29, 2013

Can Emotional Intelligence Be Taught?

By Jennifer Kahn
The New York Times
Originally published September 15, 2013

Here is an excerpt:

For children, Brackett notes, school is an emotional caldron: a constant stream of academic and social challenges that can generate feelings ranging from loneliness to euphoria. Educators and parents have long assumed that a child’s ability to cope with such stresses is either innate — a matter of temperament — or else acquired “along the way,” in the rough and tumble of ordinary interaction. But in practice, Brackett says, many children never develop those crucial skills. “It’s like saying that a child doesn’t need to study English because she talks with her parents at home,” Brackett told me last spring. “Emotional skills are the same. A teacher might say, ‘Calm down!’ — but how exactly do you calm down when you’re feeling anxious? Where do you learn the skills to manage those feelings?”

A growing number of educators and psychologists now believe that the answer to that question is in school. George Lucas’s Edutopia foundation has lobbied for the teaching of social and emotional skills for the past decade; the State of Illinois passed a bill in 2003 making “social and emotional learning” a part of school curriculums. Thousands of schools now use one of the several dozen programs, including Brackett’s own, that have been approved as “evidence-based” by the Collaborative for Academic, Social and Emotional Learning, a Chicago-based nonprofit. All told, there are now tens of thousands of emotional-literacy programs running in cities nationwide.

The theory that kids need to learn to manage their emotions in order to reach their potential grew out of the research of a pair of psychology professors — John Mayer, at the University of New Hampshire, and Peter Salovey, at Yale.

The entire story is here.

New rules for doctors ensuring data confidentiality

British Medical Association
Originally published September 13, 2013

Doctors will be asked to abide by new rules for keeping confidential patient data safe.

The government yesterday published its final response to a review into the way information is handled in and by the NHS, alongside new guidance from the HSCIC (Health and Social Care Information Centre).

The government accepted the recommendations of the review, chaired by Dame Fiona Caldicott, and stressed while information sharing was essential to provide good care for everyone, only the minimum amount of information should be shared and there must be strict rules to govern it.

Patients must also be given the right to object to having their identifiable data shared.

The entire article is here.

Saturday, September 28, 2013

Perception of Addiction and Its Effects on One's Moral Responsibility

By Justin Caouette
AJOB Neuroscience
Volume 4, Issue 3, 2013

Addressing concerns about framing addiction as disease, authors (Hammer et. al 2013) argue that we should refrain from doing so as such a categorization may unfairly stigmatize the addict.  They suggest that an analysis of disease metaphors bolsters their view, and the utility that could be had by labeling addiction as disease is outweighed by the potential disutility in doing so. Tolend support to their view they appeal to intuitions about the common folk‟s analysis of diseased individuals. Their claim is that a common understanding of disease unfairly depicts addicts as “wretches” or “sinners”.   They use this as evidence in favor of rejecting the addiction -as-disease model. We argue that the author‟s metaphoric framing of how common folks often view diseased individuals is misguided for a number of reasons. We focus on three points of contention.

The entire piece is here.

Girl’s Suicide Points to Rise in Apps Used by Cyberbullies

By LIZETTE ALVAREZ
The New York Times
Published: September 13, 2013

Here is an excerpt:

In jumping, Rebecca became one of the youngest members of a growing list of children and teenagers apparently driven to suicide, at least in part, after being maligned, threatened and taunted online, mostly through a new collection of texting and photo-sharing cellphone applications. Her suicide raises new questions about the proliferation and popularity of these applications and Web sites among children and the ability of parents to keep up with their children’s online relationships.

For more than a year, Rebecca, pretty and smart, was cyberbullied by a coterie of 15 middle-school children who urged her to kill herself, her mother said.

The entire story is here.

Friday, September 27, 2013

'Love Hormone' May Play Wider Role in Social Interaction Than Previously Thought

Science Daily
Originally published September 11, 2013

Researchers at the Stanford University School of Medicine have shown that oxytocin -- often referred to as "the love hormone" because of its importance in the formation and maintenance of strong mother-child and sexual attachments -- is involved in a broader range of social interactions than previously understood.

The discovery may have implications for neurological disorders such as autism, as well as for scientific conceptions of our evolutionary heritage.

Scientists estimate that the advent of social living preceded the emergence of pair living by 35 million years. The new study suggests that oxytocin's role in one-on-one bonding probably evolved from an existing, broader affinity for group living.

The entire article is here.

The Drug Made Me Do It: An Examination of the Prozac Defense

By J. Marshall
The Neuroethics Blog
Originally posted September 10, 2013

The plot of a recent Hollywood thriller, Side Effects, revolves around many pressing legal and ethical questions surrounding the use of anti-depressant medications. The movie explores the life of a supposedly depressed woman—Emily Taylor—who seeks treatment from her psychiatrist. Emily’s doctor prescribes her an anti-depressant—Ablixa. Emily then proceeds to murder her husband in cold blood while under the influence of the drug. The movie seeks to explore the culpability of this depressed woman in a legal sense. During the trial, the psychiatrist argues that neither he nor Emily Taylor is responsible; rather, Emily Taylor was simply “a hopeless victim of circumstance and biology.” Is it possible that a drug could be responsible for one’s actions as argued by the psychiatrist in the movie? The answer is not clear. Nonetheless, the possibility that someone could escape criminal punishment due to a certain anti-depressant represents a serious ethical quandary that should be examined.

The entire blog post is here.

Thursday, September 26, 2013

Strengthening Global Privacy & Free Expression Rights in the Age of Surveillance

by Emma Llansó
Center for Democracy and Technology
September 10, 2013

During this summer of surveillance, debate in the United States has focused mainly on the extent to which the NSA’s surveillance programs infringed on the privacy of people inside the U.S. Under the now-notorious PRISM program, the U.S. National Security Agency (NSA) requires U.S.-based companies to disclose the communications of non-U.S. citizens located outside the U.S. In defense of the program, U.S. government officials have stressed that it only targets non-U.S. citizens outside the U.S., but people across the globe who get swept up in the NSA’s programs have privacy rights too. CDT has joined human rights advocates from around the world to highlight this issue to the UN Human Rights Council, the U.S. Congress, and the Privacy and Civil Liberties Oversight Board.

The entire article is here.

Why Rational People Buy Into Conspiracy Theories

Wednesday, September 25, 2013

RSA Animate - The Truth About Dishonesty

Are you more honest than a banker? Under what circumstances would you lie, or cheat, and what effect does your deception have on society at large? Dan Ariely, one of the world's leading voices on human motivation and behaviour is the latest big thinker to get the RSA Animate treatment.




Dan Ariely tells truth about dishonesty, being irrational

Behavioral economist Dan Ariely says it's human to act irrationally, that most people lie, but that we can trust each other.

By Karen Ravn
The Los Angeles Times
Originally published September 6, 2013

Most of us would rather not think of ourselves as irrational or dishonest. But in the books "Predictably Irrational" and "The (Honest) Truth About Dishonesty," Dan Ariely, a behavioral economist at Duke University, makes the case that we're all probably both. And what's more, he says, that's not entirely bad.

Does everyone behave irrationally sometimes?

Absolutely yes. Irrationality is not about stupidity. It's about being human. Actually it's about both. Sometimes we behave irrationally because we don't think, or we don't think long-term. But other times it's because we're human, because we're kind and generous and not selfish. So we're all irrational from time to time, and occasionally it's a good thing. How often we do it is hard to say. But consider texting and driving. If you text only 10% of the time that you drive, or even 1%, is that a lot or a little? The trouble is, however rarely you do it, the danger is just tremendous when you do.

The entire interview is here.

Tuesday, September 24, 2013

Survival’s Ick Factor

By JAMES GORMAN
The New York Times
Published: January 23, 2012

Disgust is the Cinderella of emotions. While fear, sadness and anger, its nasty, flashy sisters, have drawn the rapt attention of psychologists, poor disgust has been hidden away in a corner, left to muck around in the ashes.

No longer. Disgust is having its moment in the light as researchers find that it does more than cause that sick feeling in the stomach. It protects human beings from disease and parasites, and affects almost every aspect of human relations, from romance to politics.

(cut)

It adds to the popularity of disgust as a subject of basic research that it is easier to elicit in an ethical manner than anger or fear. You don’t have to insult someone or make anyone afraid for his or her life — a bad smell will do the trick. And disgust has been relatively easy to locate in the brain, where it frequents the insula, the amygdala and other regions.

The entire story is here.

Antipsychotics: Taking the Long View

By Thomas Insel
NIMH Director's Blog
Originally published on August 28, 2013

Here is an excerpt:

An article recently posted online in JAMA-Psychiatry tells an interesting story about medications and recovery.1 Wunderink and colleagues from the Netherlands report on a seven-year follow-up of 103 people with schizophrenia and related disorders who had experienced a first episode of psychosis between 2001 and 2002. After six months of symptomatic remission following antipsychotic treatment, patients were randomly assigned to either maintenance antipsychotic treatment or a tapering-off and discontinuation of the drug. As expected, the group that stopped taking their medications experienced twice the relapse rates in the early phase of the follow-up. But these rates evened out after a few years, as some patients in the maintenance group also stopped taking their medication. Most important, by seven years, the discontinuation group had achieved twice the functional recovery rate: 40.4 percent vs. only 17.6 percent among the medication maintenance group. To be clear, this study started with patients in remission and only 17 of the 103 patients—21 percent of the discontinuation group and 11 percent of the maintenance group—were off medication entirely during the last two years of follow-up. An equal number were taking very low doses of medication—meaning that roughly one-third of all study patients were eventually taking little or no medication.

Emphasis added.

The entire blog post is here.

Thanks to Tom Fink for this story.

Monday, September 23, 2013

The Partially Examined Life Podcast: Aristotle’s Nichomachean Ethics

Discussing Books 1 and 2.

What is virtue, and how can I eat it? Do not enjoy this episode too much, or too little, but just the right amount. Apparently, if you haven’t already have been brought up with the right habits, you may as well give up. Plus, is Michael Jackson the Aristotelian ideal?

The podcast can be heard here.

All ethics and morality audio resources as they apply to psychology can be found here.

The Suicide Paradox: Freakonomics Podcast

Freakonomics Podcast
Originally posted September 5, 2013

There are more than twice as many suicides as murders in the U.S., but suicide attracts far less scrutiny. Freakonomics Radio digs through the numbers and finds all kinds of surprises.

Download the podcast or listen to it here.

There are some interesting insights, research, examples, and theories on this podcast.

This podcast link will remain in the Audio Resources section.

Thanks to Gregory Milbourne for sharing this podcast.

Sunday, September 22, 2013

Book Review: 'Behind the Shock Machine' by Gina Perry

By Carol Tavris
The Wall Street Journal
Originally published September 6, 2013

Here is an excerpt:

To almost everyone's surprise at the time, upward of two-thirds of the participant-teachers administered what they thought were the highest levels of shock, even though many were sweating and suffering over the pain they believed they were inflicting on a stranger in the name of science. Milgram's experiment produced a firestorm of protest about the potential psychological harm inflicted on the unwitting participants. As a result, it could never be done today in its original version.

Some people hated the method and others the message, but the Milgram study has never faded from public attention. It has been endlessly retold in schoolrooms, textbooks, TV programs, novels, songs and films. What, then, is left to say about it?

According to Gina Perry, an Australian psychologist and journalist, everything. She has investigated every aspect of the research and spoken with seemingly anyone who had a connection to Milgram (1933-84). She describes each of Milgram's 24 experimental variations on the basic obedience paradigm. She interviewed some of the original subjects, the son of the man who played the "learner," Milgram's research assistants, his colleagues and students, his critics and defenders, and his biographer. She listened to audiotapes of the participants made during and after the experiments. She pored through the archives of Milgram's voluminous unpublished papers.

The entire book review is here, unfortunately, behind a paywall.

The New Science of Mind

By ERIC R. KANDEL
The New York Times
Published: September 6, 2013

Here is an excerpt:

These results show us four very important things about the biology of mental disorders. First, the neural circuits disturbed by psychiatric disorders are likely to be very complex.

Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication.

Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does.

And fourth, the effects of psychotherapy can be studied empirically. Aaron Beck, who pioneered the use of cognitive behavioral therapy, long insisted that psychotherapy has an empirical basis, that it is a science. Other forms of psychotherapy have been slower to move in this direction, in part because a number of psychotherapists believed that human behavior is too difficult to study in scientific terms.

ANY discussion of the biological basis of psychiatric disorders must include genetics. And, indeed, we are beginning to fit new pieces into the puzzle of how genetic mutations influence brain development.

The entire story is here.

Saturday, September 21, 2013

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Guantanamo Ethics

Religion and Ethics Newsweekly
Originally published September 6, 2013

A growing movement is renewing calls for the facility at Guantanamo Bay to be closed, citing concerns about the treatment of prisoners. Especially troubling for human rights activists is the practice of force-feeding detainees against their will. “They’re prisoners, but that doesn’t mean that they’ve given up every right that they have as a human being,” says a US Naval Academy professor who visited Gitmo in 2009.

Watch the video here.

N.S.A. Able to Foil Basic Safeguards of Privacy on Web

By NICOLE PERLROTH, JEFF LARSON and SCOTT SHANE
The New York Times
Published: September 5, 2013

The National Security Agency is winning its long-running secret war on encryption, using supercomputers, technical trickery, court orders and behind-the-scenes persuasion to undermine the major tools protecting the privacy of everyday communications in the Internet age, according to newly disclosed documents.

The agency has circumvented or cracked much of the encryption, or digital scrambling, that guards global commerce and banking systems, protects sensitive data like trade secrets and medical records, and automatically secures the e-mails, Web searches, Internet chats and phone calls of Americans and others around the world, the documents show.

The entire article is here.

With this information, how will you contemplate and explain important clinical issues such as privacy of Protected Health Information as a part of informed consent?

Friday, September 20, 2013

Response to Critics of The Moral Landscape

By Sam Harris
His Blog
January 29, 2011

Here are two excerpts:

The problem posed by public criticism is by no means limited to the question of what to do about misrepresentations of one’s work. There is simply no good forum in which to respond to reviews of any kind, no matter how substantive. To do so in a separate essay is to risk confusing readers with a litany of disconnected points or—worse—boring them to salt. And any author who rises to the defense of his own book is always in danger of looking petulant, vain, and ineffectual. There is a galling asymmetry at work here: to say anything at all in response to criticism is to risk doing one’s reputation further harm by appearing to care too much about it.

These strictures now weigh heavily on me, because I recently published a book, The Moral Landscape: How Science Can Determine Human Values, which has provoked a backlash in intellectual (and not-so-intellectual) circles. I knew this was coming, given my thesis, but this knowledge left me no better equipped to meet the cloudbursts of vitriol and confusion once they arrived. Watching the tide of opinion turn against me, it has been difficult to know what, if anything, to do about it.

(cut)

For those unfamiliar with my book, here is my argument in brief: Morality and values depend on the existence of conscious minds—and specifically on the fact that such minds can experience various forms of well-being and suffering in this universe. Conscious minds and their states are natural phenomena, of course, fully constrained by the laws of Nature (whatever these turn out to be in the end). Therefore, there must be right and wrong answers to questions of morality and values that potentially fall within the purview of science. On this view, some people and cultures will be right (to a greater or lesser degree), and some will be wrong, with respect to what they deem important in life.

The entire blog post is here.


The Cheater's High: The Unexpected Affective Benefits of Unethical Behavior

By Nicole Ruedy, Celia Moore, Francesca Gino, & Maurice E. Schweitzer

Abstract
 
Many theories of moral behavior share the assumption that unethical behavior triggers negative affect. In this paper, we challenge this assumption and demonstrate that unethical behavior can trigger positive affect, which we term a “cheater’s high.” Across six studies, we find that even though individuals predict they will feel guilty and have increased levels of negative affect after engaging in unethical behavior (Studies 1a and 1b), individuals who cheat on different problem-solving tasks consistently experience more positive affect than those who do not (Studies 2-5). We find that this heightened positive affect is not due to the accrual of undeserved financial incentives (Study 3) and does not depend on self-selection (Study 4). Cheating is associated with feelings of self-satisfaction, and the boost in positive affect from cheating persists even when cheaters acknowledge that their self-reported performance is unreliable (Study 5). Thus, even when prospects for self-deception about unethical behavior have been reduced, the high cheaters experience from “getting away with it” overwhelms the negative affective consequences that people mistakenly predict they will experience after engaging in unethical behavior. Our results have important implications for models of ethical decision making, moral behavior, and self-regulatory theory.

The entire paper is here.

Thursday, September 19, 2013

To Bee or not To Bee: Punishment, bee keeping, and the virtue of making choices

By Katrina Siefferd
Psychiatric Ethics Blog - Kerry Gutridge
Originally posted August 28, 2013

Here is an excerpt:

Recently I’ve been thinking about the importance of rehabilitative programs and alternative sentencing from the perspective of Aristotelian virtue theory. Virtue theory supports such programs as an important way to recognize offenders’ moral agency. Moral agency involves the ability of a person to act such that their actions deserve praise or blame. Virtue theory sees choice-making as the primary means for a moral agent to develop and exercise character traits: by choosing generous actions one becomes more generous, and in turn, being generous allows one to choose generous actions more easily. The theory provides a means for critiquing punishments that unfairly impose upon this process of moral development.

The Aristotelian label for this process – where character traits like honesty, kindness and courage become stable – is “habituation.” Habituation involves practicing the trait via the use of practical reason, which allows a person to determine which actions are appropriate in any given situation. A stable disposition to act in accordance with a trait, such as honesty, is established as a result of making appropriately honest choices over time and in a variety of circumstances. However, even stable traits do not dictate automatic behavioral responses: if they were, changes in character would be impossible. Instead, traits should be seen as flexible reasons-responsive dispositions to behave that are in constant development or decline, depending on the choices that one makes (see Annas 2011; Webber 2006).

The entire blog post is here.

Fighting the Good Fight: The Relationship Between Belief in Evil and Support for Violent Policies

Campbell M & Vollhardt JR
Personality and Social Psychology Bulletin
DOI: 10.1177/0146167213500997

Abstract

The rhetoric of good and evil is prevalent in many areas of society and is often used to garner support for "redemptive violence" (i.e., using violence to rid and save the world from evil). While evil is discussed in psychological literature, beliefs about good and evil have not received adequate empirical attention as predictors of violent versus peaceful intergroup attitudes. In four survey studies, we developed and tested novel measures of belief in evil and endorsement of redemptive violence. Across four different samples, belief in evil predicted greater support for violence and lesser support for nonviolent responses. These effects were, in most cases, mediated by endorsement of redemptive violence. Structural equation modeling suggested that need for cognitive closure predicts belief in evil, and that the effect of belief in evil on support for violence is independent of right-wing authoritarianism, religious fundamentalism, and dangerous world beliefs.

The entire article is here.

Wednesday, September 18, 2013

Hard Feelings: The Moral Psychology of Contempt - Book Review

Macalester Bell, Hard Feelings: The Moral Psychology of Contempt, Oxford University Press, 2013 ISBN 9780199794140.

Reviewed by Robert C. Roberts, Baylor University

Macalester Bell defends contempt as a moral emotion and recommends cultivating a disposition to feel apt contempt. She endorses a general account of emotions on which they are "cognitive" without implying belief or judgment of their content; rather, they are perception-like, "presenting" objects in one evaluative dimension or another. Contempt in particular has four salient properties. 1) It takes whole persons (rather than persons' actions or character traits) as its object; thus it is a "globalist" or "totalizing" evaluative perception of its target (usually some person or group, though institutions can also be contemned). 2) It is a "dismissive and insulting attitude that manifests disregard for its target" (8, italics original), presenting him or her as low in status by some standard of value that the subject cares about. 3) It is comparative or reflexive; "the contemnor makes a comparison between herself and the object of her contempt, and sees the contemned as inferior to her along some axis of comparison" (41). 4) Characteristically the subject shuns or withdraws from involvement with the object of contempt.

Bell clarifies the concept of contempt by comparing it with other hard feelings. Whereas contempt focuses on a person, attributes "badbeing," and motivates withdrawal, resentment focuses on an act, attributes wrongdoing, and motivates engagement with the target. Disgust is like contempt in presenting its object as "threatening" and motivating withdrawal, but it differs in often involving a somatic reaction, in not being hierarchical, comparative, and reflexive, and in construing its object as contaminated rather than low in status. Moral hatred differs from moral contempt in not being necessarily comparative and in motivating active engagement with the object rather than withdrawal. Bell also distinguishes active from passive contempt: whereas active contempt presents the target as "threatening," passive contempt hardly presents the target at all, regarding and treating the target as almost beneath notice. Most of the book is about active contempt, though it contains nice discussions of passive contempt as commended by Aristotle and Nietzsche. Bell also discusses Kant's discussion of contempt, and shows it to be surprisingly sympathetic to this emotion.

The entire review is here.

The moral behavior of ethics professors: Relationships among self-reported behavior, expressed normative attitude, and directly observed behavior

Eric Schwitzgebel & Joshua Rust
Philosophical Psychology
DOI:10.1080/09515089.2012.727135

Abstract

Do philosophy professors specializing in ethics behave, on average, any morally better than do other professors? If not, do they at least behave more consistently with their expressed values? These questions have never been systematically studied. We examine the self-reported moral attitudes and moral behavior of 198 ethics professors, 208 non-ethicist philosophers, and 167 professors in departments other than philosophy on eight moral issues: academic society membership, voting, staying in touch with one's mother, vegetarianism, organ and blood donation, responsiveness to student emails, charitable giving, and honesty in responding to survey questionnaires. On some issues, we also had direct behavioral measures that we could compare with the self-reports. Ethicists expressed somewhat more stringent normative attitudes on some issues, such as vegetarianism and charitable donation. However, on no issue did ethicists show unequivocally better behavior than the two comparison groups. Our findings on attitude-behavior consistency were mixed: ethicists showed the strongest relationship between behavior and expressed moral attitude regarding voting but the weakest regarding charitable donation. We discuss implications for several models of the relationship between philosophical reflection and real-world moral behavior.

The article is here, hiding behind a paywall.

Tuesday, September 17, 2013

The Psychiatric Drug Crisis

BY GARY GREENBERG
The New Yorker
Originally posted on September 3, 2013

It’s been just over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.

Yet the psychiatric-drug industry is in trouble. “We are facing a crisis,” the Cornell psychiatrist and New York Times contributor Richard Friedman warned last week. In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline has been allowed to run dry.

The entire story is here.

Thanks to Tom Fink for this story.

Edward Snowden, Chelsea Manning and Julian Assange: our new heroes

As the NSA revelations have shown, whistleblowing is now an essential art. It is our means of keeping 'public reason' alive

By Slavoj Žižek
The Guardian
Originally published September 3, 2013

Here is an excerpt:

Back in 1843, the young Karl Marx claimed that the German ancien regime "only imagines that it believes in itself and demands that the world should imagine the same thing". In such a situation, to put shame on those in power becomes a weapon. Or, as Marx goes on: "The actual pressure must be made more pressing by adding to it consciousness of pressure, the shame must be made more shameful by publicising it."

This, exactly, is our situation today: we are facing the shameless cynicism of the representatives of the existing global order, who only imagine that they believe in their ideas of democracy, human rights etc. What happens in WikiLeaks disclosures is that the shame – theirs, and ours for tolerating such power over us – is made more shameful by publicising it. What we should be ashamed of is the worldwide process of the gradual narrowing of the space for what Kant called the Immanuel "public use of reason".

In his classic text, What Is Enlightenment?, Kant contrasts "public" and "private" use of reason – "private" is for Kant the communal-institutional order in which we dwell (our state, our nation …), while "public" is the transnational universality of the exercise of one's reason: "The public use of one's reason must always be free, and it alone can bring about enlightenment among men. The private use of one's reason, on the other hand, may often be very narrowly restricted without particularly hindering the progress of enlightenment. By public use of one's reason I understand the use that a person makes of it as a scholar before the reading public. Private use I call that which one may make of it in a particular civil post or office which is entrusted to him."

The entire article is here.

Monday, September 16, 2013

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it.

By Sheryl Cash
amdnews.com
Originally posted August 26, 2013

The University of Pennsylvania Health System and its affiliates recently joined Cleveland Clinic and other hospitals in banning the employment of smokers. Proponents say such policies lower health care costs and improve employee and community health. Others believe these restrictions may be the beginning of a slippery ethical slope in which employees can be fired or banned for personal decisions and activities unrelated to their specific jobs.

The question is: Will and can private physician practices soon follow suit, banning or disciplining employees not only for smoking but also for other outside activities deemed detrimental to the image of the group? What about obesity, social media presence, hobbies and other after-work activities? Are there legitimate situations where the needs and mission of the practice, and the protection of its patients, outweigh the individual rights of the employee and potential employee? In general, are these types of bans legal and ethical?

The entire story is here.

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity.

By Kevin B. O'Reilly
amdnews.com
Originally posted September 2, 2013

Here is an excerpt:

Because few physicians, medical students or others will admit openly to bias, researchers have developed a tool to plumb their unconscious attitudes. The Weight Implicit Association Test asks participants to pair images of “thin” or “fat” people with negative or positive words. The faster the test-taker links the type of person to a negative attribute, the stronger the unconscious negative attitude. The validated survey tool has been used to measure implicit biases related to race, age, gender, sexuality and other areas.

The vast majority of the people who take the Web-based test exhibit a strong preference for thin people and associate the fat people with negative words, and nearly 2,300 physicians scored about the same as the general populace, said a study published Nov. 7, 2012, in PLoS One. A survey of 620 U.S. doctors found that more than half viewed obese patients as “awkward, unattractive, ugly and noncompliant with therapy,” said a study published October 2003 in Obesity Research.

The entire article is here.

Sunday, September 15, 2013

Military And Veteran Suicides Rise Despite Aggressive Prevention Efforts

By David Wood
The Huffington Post
Originally posted August 30, 2013

Here is an excerpt:

The bad news: the number of military and veteran suicides is rising, and experts fear it will continue to rise despite aggressive suicide prevention campaigns by the government and private organizations.

The Pentagon and Department of Veterans Affairs (VA), already struggling to meet an increasing demand from troops and veterans for mental health services, are watching the suicide rates, and the growing number of those considered "at risk" of suicide, with apprehension.

"It really is extremely concerning," said Caitlin Thompson, a VA psychologist and clinical care coordinator at the national crisis line for the military and veterans.

The entire story is here.

Kansas Sportswriter's "Suicide Website" Is a Troubling Template for 21st-Century Suicide Notes

By Will Oremus | Posted Friday, Aug. 16, 2013
Slate Magazine

Suicide is, generally speaking, a tragic and hideously hurtful act. Martin Manley, a 60-year-old former sports writer and statistician for the Kansas City Star, seems to have been at least vaguely aware of that. But he did it anyway—and left behind a meticulously detailed website explaining virtually every aspect of his decision.


The case is noteworthy not so much because Manley was a semi-public figure—though he was credited with popularizing the NBA’s standard efficiency rating—but because he used technology to intentionally blow open the wall of privacy that typically surrounds suicides. More than 100 people die by suicide on an average day in the United States, and a significant portion of them leave notes for their stricken friends and relatives. Some are vengeful, some apologetic, some maddeningly cryptic. Regardless, most are read only by a small circle of authorities and loved ones. For Manley, confronting friends and family with his death wasn’t enough. He wanted to confront the public at large. He wanted desperately to justify his own life and death—to the world, but perhaps above all to himself.

The entire article is here.

The original site was taken down by Yahoo as it violated their Terms of Service.  Anonymous hosts a "mirror site" for those interested in the content.

Thanks to Gregory Milbourne for the information.

Saturday, September 14, 2013

How online ratings affect your judgment

MedicalNewsToday
Originally published August 12, 2013

Here are two excerpts:

A new study co-authored by an MIT professor suggests that many people are, in fact, heavily influenced by the positive opinions other people express online - but are much less swayed by negative opinions posted in the same venues. Certain topics, including politics, see much more of this "herding" effect than others.

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"This herding behavior happens systematically on positive signals of quality and ratings," says Sinan Aral, an associate professor at the MIT Sloan School of Management, and one of three authors of the study. At the same time, Aral notes, the results "were asymmetric between positive and negative herding." Comments given negative ratings attracted more negative judgments, but that increase was drowned out by what the researchers call a "correction effect" of additional positive responses.

The entire article is here.

Internet Access Is Not a Human Right

By VINTON G. CERF
The New York Times
Published: January 4, 2012 (and still relevant today)

Here is an excerpt:

Over the past few years, courts and parliaments in countries like France and Estonia have pronounced Internet access a human right.

But that argument, however well meaning, misses a larger point: technology is an enabler of rights, not a right itself. There is a high bar for something to be considered a human right. Loosely put, it must be among the things we as humans need in order to lead healthy, meaningful lives, like freedom from torture or freedom of conscience. It is a mistake to place any particular technology in this exalted category, since over time we will end up valuing the wrong things. For example, at one time if you didn’t have a horse it was hard to make a living. But the important right in that case was the right to make a living, not the right to a horse. Today, if I were granted a right to have a horse, I’m not sure where I would put it.

The entire piece is here.

Friday, September 13, 2013

U.S. Nursing Homes Reducing Use of Antipsychotic Drugs

By Alan Mozes
MedicineNet.com
Originally published August 27, 2013

A year-old nationwide effort to prevent the unnecessary use of antipsychotic medications in U.S. nursing homes already seems to be working, public health officials report, as facilities begin to opt for patient-centered approaches over drugs to treat dementia and other related complications.

So far, the program has seen more than a 9 percent drop in the national use of antipsychotics among long-term nursing-home residents, when comparing the period of January to March 2013 with October to December 2011.

The entire story is here.

50 years after March on Washington: Americans' views on race

By Sarah Dutton, Jennifer De Pinto, Anthony Salvanto and Fred Backus
CBS NEWS/ August 28, 2013

Fifty years after the March on Washington, there is a wide divergence between the views of white and black Americans on the issue of racial discrimination. While sizeable majorities of both whites and blacks think there is at least some racial discrimination today, blacks are more apt to say it is widespread. Forty percent of blacks say there is a lot of discrimination against African-Americans today, compared to just 15 percent of whites who say that.

Differing views may be a result of different personal experiences. Just 29 percent of whites say they can think of a specific instance where they felt discriminated against because of their race, but this rises to 62 percent among blacks.

The entire story is here.

Thursday, September 12, 2013

Why Evolutionary Science Is The Key To Moral Progress

By Michael E. Price
This View of Life
Originally published July 16, 2013

Here is an excerpt:

Morality is centrally important to human affairs, for two main reasons. First, cross-culturally, the well-being of individuals is strongly affected by their moral standing: an individual held in high moral regard may be praised, rewarded, or celebrated as a hero, whereas one held in low regard may be admonished, ostracized, or put to death. Second, a society’s ability to compete with other societies may depend heavily on the content of its moral system: a moral system that successfully promotes values associated with economic and political competitiveness, for example, can be hugely advantageous to the society that hosts it. Our moral beliefs, then, have a critical impact on the fates of both the individuals we judge, and the societies to which we belong. 

Using Social Media to Boost Ethics and Compliance

By Pamela Babcock
Society for Human Resource Management
Originally published August 27, 2013

Organization leaders should take a cue from their employees and spend some time on social media, experts said.

Even though employees may misuse social media—and need to be trained on what is and is not acceptable—it is a powerful tool that companies can use to promote ethical practices and culture, a recent study found.

To more effectively engage employees, enhance ethics and compliance programs, and positively affect workplace culture, businesses should tap their employees’ expertise and encourage workers to use social media, according to a July 17, 2103, report from the Ethics Resource Center (ERC) in Arlington, Va. The key is seizing the opportunity of having tech-savvy employees who are invested in the company while mitigating the risk of inappropriate postings.

“If you can’t beat them, leverage them,” quipped ERC President Patricia J. Harned, Ph.D., adding that active social networkers “have a really strong interest in the culture of the workplace. They are more likely to be responsive if you’re making use of social networks to address company culture and employee concerns.”

The entire article is here.

Wednesday, September 11, 2013

Just Thinking about Science Triggers Moral Behavior

Psychologists find deep connection between scientific method and morality

By Piercarlo Valdesolo
Scientific America
Originally published August 27, 2013

Public opinion towards science has made headlines over the past several years for a variety of reasons — mostly negative. High profile cases of academic dishonesty and disputes over funding have left many questioning the integrity and societal value of basic science, while accusations of politically motivated research fly from left and right. There is little doubt that science is value-laden. Allegiances to theories and ideologies can skew the kinds of hypotheses tested and the methods used to test them. These, however, are errors in the application of the method, not the method itself. In other words, it’s possible that public opinion towards science more generally might be relatively unaffected by the misdeeds and biases of individual scientists.  In fact, given the undeniable benefits scientific progress yielded, associations with the process of scientific inquiry may be quite positive.

The entire story is here.

Under-Treatment, Treated.

By Iain Brassington
BMJ Group Blogs
Originally published August 29, 2013

Right: file this paper from the JAMA under “Properly Odd”: it’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right.

No, really.  Look at the title: “Medication Nonadherence: A Diagnosable and Treatable Medical Condition”.

Starting from the fairly straightforward premise that non-adherence to treatment regimes is “a common and costly problem”, Marcum et al move at the end of their opening paragraph to have medication nonadherence recognised “as a diagnosable and treatable medical condition”.

The entire blog post is here.

Tuesday, September 10, 2013

Looking to Genes for the Secret to Happiness

By GRETCHEN REYNOLDS
The New York Times
Originally published August 25, 2013

Our genes may have a more elevated moral sense than our minds do, according to a new study of the genetic effects of happiness. They can, it seems, reward us with healthy gene activity when we’re unselfish — and chastise us, at a microscopic level, when we put our own needs and desires first.

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The volunteers whose happiness was more eudaemonic, or based on a sense of higher purpose and service to others — a small minority of the overall group — had profiles that displayed augmented levels of antibody-producing gene expression and lower levels of the pro-inflammatory expression.

The entire story is here.

Human Brains Are Hardwired for Empathy, Friendship

Science Daily
Originally published August 23, 2013

Here is an excerpt:

"The correlation between self and friend was remarkably similar," Coan said. "The finding shows the brain's remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it's very real. Literally we are under threat when a friend is under threat. But not so when a stranger is under threat."

Coan said this likely is because humans need to have friends and allies who they can side with and see as being the same as themselves. And as people spend more time together, they become more similar.

The entire story is here.

Monday, September 9, 2013

Vignette 28: Another Point of View

A psychologist who completes evaluations for the Bureau of Disability Determination (BDD) calls you for a consultation.

Earlier in the day, the psychologist evaluated a 48-year-old male with a history of chronic pain.  The only documentation received from BDD was a list of medications, which included an antidepressant and a prescription sleep aid.

The disability applicant arrived late for the evaluation, reporting that his pain prevented him from being on time.  He shuffled his feet, walked in a hunched manner, used a cane, shifted in his seat frequently, and groaned throughout the evaluation.  He described rather significant cognitive and vegetative symptoms of depression.  He began to cry softly at one point when discussing the negative consequences of chronic pain.  When asked about outpatient psychological treatment, the disability applicant explained he did not know that psychotherapy could help, and he would be anxious to try therapy.

At the end of the evaluation, the patient left, shuffling and making muffled groans as he left the office and the waiting room.  When the psychologist returned to his office, he remembered a lunch date for which he was late.  As he was leaving the office building, the psychologist saw the disability applicant in the parking lot laughing with another person.  He twirled his cane with one hand.  He stood upright and seemed genuinely happy.  When the disability applicant met the psychologist’s gaze, the applicant immediately hunched over, grabbed his back, groaned loudly, and used the cane to steady himself.  The psychologist hopped in his car for lunch without any discussion with the applicant.

Knowing that BDD evaluations are used within a legal context (in that lawyers, other psychologists, and administrative law judges will see this report), the psychologist asks the following questions:

1. What are the psychologist's ethical duties to the BDD?

2. What are the psychologist's ethical duties to the applicant?

3. Is the psychologist permitted to use any of his observations outside of the office as part of his report? If so, why?  If not, why not?

4. If so, should it be included as an addendum or as part of the body of the report?

5. In either case, how do these observations influence the psychologist’s rating of truthfulness or veracity during the evaluation?

6. Does the psychologist have any obligation to clarify what happened in the parking lot with the disability applicant by phone?

7. If not, how should the psychologist respond if the disability applicant calls him to discuss the evaluation or the interaction in the parking lot?

8. Is it appropriate to use the term “malingering” in the report, given that there is such a small sample of behavior?

Is Individuality the Savior of Eugenics?

By Nathaniel Comfort
Scientific American Blog
Originally published August 23, 2013

Is eugenics a historical evil poised for a comeback? Or is it a noble but oft-abused concept, finally being done correctly?

Once defined as “the science of human improvement through better breeding,” eugenics has roared back into the headlines in recent weeks in both Mr. Hyde and Dr. Jekyll personae. The close observer may well wonder which will prevail. The snarling Mr. Hyde is the state control over reproduction. Although this idea may evoke visions of Nazi genocide, the U.S. itself has a long, unsavory eugenic history, peaking between 1910 and the mid-thirties but tailing out through the 20th century. And now into the 21st: the recent investigation by the Center for Investigative Reporting, which showed that between 2006 and 2010 nearly 150 pregnant prisoners had been sterilized against their will in California, was a stunning reminder that traces of the old eugenics remain in our own time.

The entire blog post is here.

Sunday, September 8, 2013

3 Ways To Save Psychotherapy

People have been turning away from psychotherapy in favor of medication for years, despite the evidence that therapy works. Here are a few tips for improving the industry's image.

By Shaunacy Ferro
www.popsi.com
Posted 08.21.2013

The subtle art of lying on a therapist's couch is in rapid decline. Psychotherapy, the traditional one-on-one weekly session with a therapist, has been on the downswing for years, as more and more psychiatrists and even primary care doctors prescribe psychotropic medications instead of therapy. As the graphic above illustrates, between 1998 and 2007, psychotherapy use for people being treated for mental health conditions in the U.S. decreased from almost 16 percent to 10.5 percent, and therapy use in conjunction with medication went from 40 percent to 32 percent. By contrast, usage rates of medication alone shot up from 41 percent to a little more than 57 percent.

The entire story is here.

The reality show: The Truman Show Delusion

Schizophrenics used to see demons and spirits. Now they talk about actors and hidden cameras – and make a lot of sense

By Mike Jay
Aeon Magazine

Here is an excerpt:

The Gold brothers’ interpretation of the Truman Show delusion runs along similar lines. It might appear to be a new phenomenon that has emerged in response to our hypermodern media culture, but is in fact a familiar condition given a modern makeover. They make a primary distinction between the content of delusions, which is spectacularly varied and imaginative, and the basic forms of delusion, which they characterise as ‘both universal and rather small in number’.

Persecutory delusions, for example, can be found throughout history and across cultures; but within this category a desert nomad is more likely to believe that he is being buried alive in sand by a djinn, and an urban American that he has been implanted with a microchip and is being monitored by the CIA. ‘For an illness that is often characterised as a break with reality,’ they observe, ‘psychosis keeps remarkably up to date.’ Rather than being estranged from the culture around them, psychotic subjects can be seen as consumed by it: unable to establish the boundaries of the self, they are at the mercy of their often heightened sensitivity to social threats.

The entire article is here.

Saturday, September 7, 2013

Institutional Corruption and Pharmaceutical Policy

Institutional Corruption and Pharmaceutical Policy
An Edmond J. Safra Center Symposium
(forthcoming)
Journal of Law, Medicine and Ethics 
Vol. 14, No. 3 (2013)

The goals of pharmaceutical policy and medical practice are often undermined due to institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or integrity. The pharmaceutical industry’s own purposes are often undermined. In addition, pharmaceutical industry funding of election campaigns and lobbying skews the legislative process that sets pharmaceutical policy. Moreover, certain practices have corrupted medical research, the production of medical knowledge, the practice of medicine, drug safety, and the Food and Drug Administration’s oversight of pharmaceutical marketing.

As a result, practitioners may think they are using reliable information to engage in sound medical practice while actually relying on misleading information and therefore prescribe drugs that are unnecessary or harmful to patients, or more costly than equivalent medications. At the same time, patients and the public may believe that patient advocacy organizations effectively represent their interests while these organizations actually neglect their interests.

The entire journal is here.

The articles are organized into five topics: (1) systemic problems, (2) medical research, (3) medical knowledge and practice, (4) marketing, and (5) patient advocacy organizations.

Physicians Under the Influence: Social Psychology and Industry Marketing Strategies

By Sunita Sah and Adriane Fugh-Berman
April 30, 2013

Journal of Law, Medicine and Ethics, Volume 14, No. 3, August 2013,
Forthcoming Edmond J. Safra Working Papers, Forthcoming

Abstract

Pharmaceutical and medical device companies apply social psychology to influence physicians’ prescribing behavior and decision-making. Physicians fail to recognize their vulnerability to commercial influences; due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry’s routine marketing strategies, which rely on the illusion that the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias, and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame, rather than gratitude, will reduce conflicts of interest. If greater academic prestige accrues to distant, rather than close relationships with industry, a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated, but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession’s improper dependence on industry.

The entire paper is here.

Friday, September 6, 2013

Dangerous Doctors Allowed to Keep Practicing

By Peter Eisler and Barbara Hansen
USA Today
Originally published August 20, 2013

Here is an excerpt:

Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.

The problem isn't universal. Some state boards have responded to complaints and become more transparent and aggressive in policing bad doctors.

But state and federal records still paint a grim picture of a physician oversight system that often is slow to act, quick to excuse problems, and struggling to manage workloads in an era of tight state budgets.

USA TODAY reviewed records from multiple sources, including the public file of the National Practitioner Data Bank, a federal repository set up to help medical boards track physicians' license records, malpractice payments, and disciplinary actions imposed by hospitals, HMOs and other institutions that manage doctors. By law, reports must be filed with the Data Bank when any of the nation's 878,000 licensed doctors face "adverse actions" — and the reports are intended to be monitored closely by medical boards.

The entire narrative and video story is here.

Is prostitution harmful? - Views on Sexual Ethics

Ole Martin Moen
J Med Ethics doi:10.1136/medethics-2011-100367

Abstract

A common argument against prostitution states that selling sex is harmful because it involves selling something deeply personal and emotional. More and more of us, however, believe that sexual encounters need not be deeply personal and emotional in order to be acceptable—we believe in the acceptability of casual sex. In this paper I argue that if casual sex is acceptable, then we have few or no reasons to reject prostitution. I do so by first examining nine influential arguments to the contrary. These arguments purport to pin down the alleged additional harm brought about by prostitution (compared to just casual sex) by appealing to various aspects of its practice, such as its psychology, physiology, economics and social meaning. For each argument I explain why it is unconvincing. I then weight the costs against the benefits of prostitution, and argue that, in sum, prostitution is no more harmful than a long line of occupations that we commonly accept without hesitation.

The entire article is here.

Thursday, September 5, 2013

Doctors Face New Scrutiny Over Gifts

By Peter Loftus
The Wall Street Journal
Originally published August 22, 2013

U.S. doctors are bracing for increased public scrutiny of the payments and gifts they receive from pharmaceutical and medical-device companies as a result of the new health law.

Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the so-called Sunshine Act provision of the U.S. health-care overhaul. The companies must report data on individual doctors and how much they received to a federal health agency, which will post it on a searchable, public website beginning September 2014.


Many doctors say the increased disclosures are making them rethink their relationships with industry, citing concerns about privacy and accuracy, and worry that the public will misinterpret the information. Some fear patients will view the payments as tainting their medical decisions, and will lump together compensation for research-related services with payments of a more promotional nature.

A Dry Pipeline for Psychiatric Drugs

By RICHARD A. FRIEDMAN, M.D.
The New York Times
Published: August 19, 2013

Fully 1 in 5 Americans take at least one psychiatric medication. Yet when it comes to mental health, we are facing a crisis in drug innovation.

Sure, we have many antidepressants, antipsychotics, hypnotic medications and the like. But their popularity masks two serious problems.

First, each of these drug classes is filled with “me too” drugs, which are essentially just copies of one another; we have six S.S.R.I. antidepressants that essentially do the same thing, and likewise for the 10 new atypical antipsychotic drugs.

Second, the available drugs leave a lot to be desired: patients with illnesses like schizophrenia, major depression and bipolar disorder often fail to respond adequately to these medications or cannot tolerate their side effects.

The entire story is here.

Wednesday, September 4, 2013

The Contribution of the Quality of Therapists' Personal Lives to the Development of the Working Alliance

By Helene A. Nissen-Lie, Odd E. Havik, Per A. Hoglend, Jon T. Monsen, and Michael Helge Ronnestad
Journal of Counseling Psychology. 2013 Aug 19

Abstract

Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists' personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists' quality of life that emerged from the self-reports of a large international sample of psychotherapists (N = 4,828) (Orlinsky & Rønnestad, 2004, 2005) using the Quality of Personal Life scales of the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). These factors were investigated as predictors of alliance levels and growth (using the Working Alliance Inventory) rated by both patients and therapists in a large (227 patients and 70 therapists) naturalistic outpatient psychotherapy study (Havik et al., 1995). The Personal Burdens scale was strongly and inversely related to the growth of the alliance as rated by the patients, but was unrelated to therapist-rated alliance. Conversely, the factor scale of therapists' Personal Satisfactions was clearly and positively associated with therapist-rated alliance growth, but was unrelated to the patients' ratings of the alliance. The findings suggest that the working alliance is influenced by therapists' quality of life, but in divergent ways when rated by patients or by therapists. It seems that patients are particularly sensitive to their therapists' private life experience of distress, which presumably is communicated through the therapists' in-session behaviors, whereas the therapists' judgments of alliance quality were positively biased by their own sense of personal well-being.

Introduction

The notion that the psychotherapist as an individual is important for psychotherapeutic outcomes stems in part from the well-known and frequently cited finding of meta-analyses that therapy outcome appears to be less related to the use of different therapy methods associated with established schools of therapy, and significantly related to differences between the individual psychotherapists providing the therapy (Benish, Imel, & Wampold, 2008; Blatt, Zuroff, Quinlan, & Pilkonis, 1996; Huppert et al., 2001; Kim, Wampold, & Bolt, 2006). Moreover, in efforts to identify the characteristics in therapists that promote treatment success or failure, the studies to date suggest that experience level, type of training, theoretical orientation, and so forth have limited value in distinguishing between more or less successful therapists (Beutler et al., 2004; Dunkle & Friedlander, 1996; Sandell et al., 2007; Skovholt & Jennings, 2004; Strupp & Hadley, 1977). Instead, therapists' interpersonal qualities appear to be more relevant, such as their facilitative interpersonal skills (Anderson, Ogles, Pattersen, Lambert, & Vermeersch, 2009); their ability to be affirmative, responsive, and empathic (Bohart, Elliott, Greenberg, & Watson, 2002; Najavits & Strupp, 1994); their ability to resist counteraggression when confronted with devaluation and rejections by patients (von der Lippe, Monsen, Ronnestad, & Eilertsen, 2008); and their interpersonal functioning in their personal lives (Dunkle & Friedlander, 1996; Hersoug, Hoglend, Havik, von der Lippe, & Monsen, 2009b). Hence, although therapists are professional helpers, it may be that their personal characteristics are more important than their professional qualifications in determining their therapeutic capabilities. This suggestion echoes the statements of Rosenzweig (1936), Strupp (1958), and Rogers (1957, 1961), who emphasized that studying the personal characteristics of psychotherapists is necessary in order to understand patient development in psychotherapy.

Thanks to Ken Pope for this information.

Neuroscience and the law

Nature Reviews Neuroscience
September 2013 Vol 14 No 9

New insights into the neural processes that underlie cognition and behaviour have led to discussions about the relevance of these discoveries for the criminal justice system. Conversely, laws can influence neuroscience, for example, with regard to psychoactive drugs and stem cell research. Nature Reviews Neuroscience presents a series of articles that explore the interaction between neuroscience and the law.

There are three articles at this site are behind paywalls.

The neuroscience of memory: implications for the courtroom
Joyce W. Lacy & Craig E. L. Stark

Effects of Schedule I drug laws on neuroscience research and treatment innovation
David J. Nutt, Leslie A. King & David E. Nichols

The influence of neuroscience on US Supreme Court decisions about adolescents' criminal culpability
Laurence Steinberg

These articles can be found here.

Tuesday, September 3, 2013

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

By H. Knuppel, M. Mertz, M. Schmidhuber, G. Neitzke, and D. Strech
PLOS Medicine - Open Access

Ethical issues were inconsistently addressed in national dementia guidelines, with some guidelines including most and some including few ethical issues. Guidelines should address ethical issues and how to deal with them to help the medical profession understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines. There is a need for further research to specify how detailed ethical issues and their respective recommendations can and should be addressed in dementia guidelines.

The entire article is here.

End of Life Decisions: Measuring Consciousness

By David DiSalvo
Forbes Magazine
Originally published August 17, 2013

An experimental tool designed to “peek” into a patient’s brain and find signs of consciousness could eventually give doctors a way to more accurately judge chances of recovery from serious brain trauma – and in the process change the nature of end-of-life decisions.

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This knowledge could potentially change the way end-of-life decisions are made by providing doctors and loved ones with a firmer means to evaluate whether a patient has the capacity to recover.

The entire story is here.

Monday, September 2, 2013

Moral Mondays

Religious and Ethics Weekly
August 23, 2013

Religious leaders in North Carolina are being arrested in growing numbers to protest new laws they say adversely affect the poor, the aging, and children.



Watch Moral Mondays on PBS. See more from Religion & Ethics NewsWeekly.

Michel Foucault’s Controversial Life and Philosophy

Published by OpenCulture here.

Michel Foucault’s colorful life and hugely influential work were both struggles against limitation—the limits of language, of social structures and stultifying historical identities.



Sunday, September 1, 2013

Good Deeds Gone Bad

By MATTHEW HUTSON
The New York Times
Published: August 16, 2013

ON your way to work today you may have paused to let another car merge into your lane. Or you stopped to give a dollar to a subway artist. A minute later, another chance to do the same may have appeared. Did your first act make the second more tempting? Or did you decide you had done your good deed for the day?

Strangely, researchers have demonstrated both reactions — moral consistency and moral compensation — repeatedly in laboratories, leading them to ask why virtue sometimes begets more virtue and sometimes allows for vice. In doing so, they have shed an interesting light on how the conscience works.

We often look to past behavior for clues about who we are and what we want, and then behave accordingly. Of course, we seek consistency not only with desirable behaviors, but also with less noble acts: in one study, subjects assigned to wear sunglasses they knew were counterfeit were more likely to cheat during the experiment.

The entire article is here.

Looking at the HIPAA Final Omnibus Rule: An Attorney’s Perspective

By Mark Hagland
Healthcare Informatics
Originally published August 18, 2013

The stringent requirements embedded in what is being called the “HIPAA Final Omnibus Rule”—a set of regulations published by the Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) on Jan. 25—are changing the ground rules for healthcare provider organizations across the U.S. when it comes to safeguarding protected health information (PHI). Those requirements extend the privacy, security, enforcement, and breach notification rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for economic and Clinical Health (HITECH) Act.

With compliance with the “Omnibus Rule” required by September 23, healthcare leaders have no time to waste when it comes to understanding and addressing the new requirements.

Recently, Kathryn Coburn, who is of counsel with the Los Altos, Calif.-based law firm of Cooke, Kobrick & Wu, LLP, spoke with HCI Editor-in-Chief Mark Hagland regarding this important topic. The Santa Monica-based Coburn has spent 30 years in healthcare law. Below are excerpts from that interview.


Thanks to Ken Pope for this information.