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

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Compliance. Show all posts
Showing posts with label Compliance. Show all posts

Saturday, October 21, 2023

Should Trackable Pill Technologies Be Used to Facilitate Adherence Among Patients Without Insight?

Tahir Rahman
AMA J Ethics. 2019;21(4):E332-336.
doi: 10.1001/amajethics.2019.332.

Abstract

Aripiprazole tablets with sensor offer a new wireless trackable form of aripiprazole that represents a clear departure from existing drug delivery systems, routes, or formulations. This tracking technology raises concerns about the ethical treatment of patients with psychosis when it could introduce unintended treatment challenges. The use of “trackable” pills and other “smart” drugs or nanodrugs assumes renewed importance given that physicians are responsible for determining patients’ decision-making capacity. Psychiatrists are uniquely positioned in society to advocate on behalf of vulnerable patients with mental health disorders. The case presented here focuses on guidance for capacity determination and informed consent for such nanodrugs.

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Ethics and Nanodrug Prescribing

Clinicians often struggle with improving treatment adherence in patients with psychosis who lack insight and decision-making capacity, so trackable nanodrugs, even though not proven to improve compliance, are worth considering. At the same time, guidelines are lacking to help clinicians determine which patients are appropriate for trackable nanodrug prescribing. The introduction of an actual tracking device in a patient who suffers from delusions of an imagined tracking device, like Mr A, raises specific ethical concerns. Clinicians have widely accepted the premise that confronting delusions is countertherapeuti The introduction of trackable pill technology could similarly introduce unintended harms. Paul Appelbaum has argued that “with paranoid patients often worried about being monitored or tracked, giving them a pill that does exactly that is an odd approach to treatment. The fear of invasion of privacy might discourage some patients from being compliant with their medical care and thus foster distrust of all psychiatric services. A good therapeutic relationship (often with family, friends, or a guardian involved) is critical to the patient’s engaging in ongoing psychiatric services.

The use of trackable pill technology to improve compliance deserves further scrutiny, as continued reliance on informal, physician determinations of decision-making capacity remain a standard practice. Most patients are not yet accustomed to the idea of ingesting a trackable pill. Therefore, explanation of the intervention must be incorporated into the informed consent process, assuming the patient has decision-making capacity. Since patients may have concerns about the collected data being stored on a device, clinicians might have to answer questions regarding potential breaches of confidentiality. They will also have to contend with clinical implications of acquiring patient treatment compliance data and justifying decisions based on such information. Below is a practical guide to aid clinicians in appropriate use of this technology.

Monday, October 2, 2023

Research: How One Bad Employee Can Corrupt a Whole Team

Stephen Dimmock & William Gerken
Harvard Business Review
Originally posted 5 March 2018

Here is an excerpt:

In our research, we wanted to understand just how contagious bad behavior is. To do so, we examined peer effects in misconduct by financial advisors, focusing on mergers between financial advisory firms that each have multiple branches. In these mergers, financial advisors meet new co-workers from one of the branches of the other firm, exposing them to new ideas and behaviors.

We collected an extensive data set using the detailed regulatory filings available for financial advisors. We defined misconduct as customer complaints for which the financial advisor either paid a settlement of at least $10,000 or lost an arbitration decision. We observed when complaints occurred for each financial advisor, as well as for the advisor’s co-workers.

We found that financial advisors are 37% more likely to commit misconduct if they encounter a new co-worker with a history of misconduct. This result implies that misconduct has a social multiplier of 1.59 — meaning that, on average, each case of misconduct results in an additional 0.59 cases of misconduct through peer effects.

However, observing similar behavior among co-workers does not explain why this similarity occurs. Co-workers could behave similarly because of peer effects – in which workers learn behaviors or social norms from each other — but similar behavior could arise because co-workers face the same incentives or because individuals prone to making similar choices naturally choose to work together.

In our research, we wanted to understand how peer effects contribute to the spread of misconduct. We compared financial advisors across different branches of the same firm, because this allowed us to control for the effect of the incentive structure faced by all advisors in the firm. We also focused on changes in co-workers caused by mergers, because this allowed us to remove the effect of advisors choosing their co-workers. As a result, we were able to isolate peer effects.


Here is my summary: 

The article discusses a study that found that even the most honest employees are more likely to commit misconduct if they work alongside a dishonest individual. The study, which was conducted by researchers at the University of California, Irvine, found that financial advisors were 37% more likely to commit misconduct if they encountered a new co-worker with a history of misconduct.

The researchers believe that this is because people are more likely to learn bad behavior than good behavior. When we see someone else getting away with misconduct, it can make us think that it's okay to do the same thing. Additionally, when we're surrounded by people who are behaving badly, it can create a culture of acceptance for misconduct.

Friday, October 30, 2020

The corporate responsibility facade is finally starting to crumble

Alison Taylor
Yahoo Finance
Originally posted 4 March 20

Here is an excerpt:

Any claim to be a responsible corporation is predicated on addressing these abuses of power. But most companies are instead clinging with remarkable persistence to the façades they’ve built to deflect attention. Compliance officers focus on pleasing regulators, even though there is limited evidence that their recommendations reduce wrongdoing. Corporate sustainability practitioners drown their messages in an alphabet soup of acronyms, initiatives, and alienating jargon about “empowered communities” and “engaged stakeholders,” when both functions are still considered peripheral to corporate strategy.

When reading a corporation’s sustainability report and then comparing it to its risk disclosures—or worse, its media coverage—we might as well be reading about entirely distinct companies. Investors focused on sustainability speak of “materiality” principles, meant to sharpen our focus on the most relevant environmental, social, and governance (ESG) issues for each industry. But when an issue is “material” enough to threaten core operating models, companies routinely ignore, evade, and equivocate.

Coca-Cola’s most recent annual sustainability report acknowledges its most pressing issue is “obesity concerns and category perceptions.” Accordingly, it highlights its lower-sugar product lines and references responsible marketing. But it continues its vigorous lobbying against soda taxes, and of course continues to make products with known links to obesity and other health problems. Facebook’s sustainability disclosures focus on efforts to fight climate change and improve labor rights in its supply chain, but make no reference to the mental-health impacts of social media or to its role in peddling disinformation and undermining democracy. Johnson and Johnson flags “product quality and safety” as its highest priority issue without mentioning that it is a defendant in criminal litigation over distribution of opioids. UBS touts its sustainability targets but not its ongoing financing of fossil-fuel projects.

Saturday, February 1, 2020

Bringing Ethics Back To Business

Tamara Pupic
entrepreneur.com
Originally posted 30 Dec 19

In the business world, detecting, preventing, and remedying compliance issues, or a lack thereof, has evolved from academic research, investigative reporting, and businesses applying best practice initiatives, often clumsily, into a niche sector - regtech,  a new sector for ‘treps to develop innovative technologies to address challenges involving regulations.

It is considered the most promising part of the global enterprise governance, risk, and compliance (EGRC) market, whose size has grown rapidly, from US$27.8 billion in 2018 to an expected $64.2 billion by 2025, according to a report by Grand View Research. In the MENA region, transparency and ethical compliance have been at the forefront of shareholder and board of directors’ discussions, especially since non-compliance cases at leading firms have started making headlines just about every other week.

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According to the leadership team, Alethia solves several of the main current challenges in compliance. Firstly, it addresses the lack of anonymity in traditional compliance hotlines and emails “People are naturally skeptical when it comes to technology and personal data,” Roets says. “We instill confidence by requiring no personal information when downloading the app, and we don’t track IP addresses. All interactions are protected with SSL encryption using digitally signed tokens to ensure 100% anonymity for the whistleblower to safeguard against any form of retaliation.” Secondly, the app urges organizations to try different reporting channels. “Most still rely on outdated anonymous telephone hotlines, but in a digital world, when we think about workforce demographics, GDPR compliance, cost implications, and the overall decline in telephone usage, hotlines are no longer best practice,” Roets says. “Other channels include intranet solutions, cumbersome online forms, or personal interactions with HR or ombudsmen. Unfortunately, these offer little by way of a follow-up feature, call handlers’ subjectivity can impact the quality of reports, and most importantly, they all present a real or perceived threat of compromising the reporter’s identity.”

The info is here.

Thursday, January 9, 2020

Artificial Intelligence Is Superseding Well-Paying Wall Street Jobs

Deutsche Boerse To Acquire NYSE Euronext To Create Largest Exchange OwnerJack Kelly
forbes.com
Originally posted 10 Dec 19

Here is an excerpt:

Compliance people run the risk of being replaced too. “As bad actors become more sophisticated, it is vital that financial regulators have the funding resources, technological capacity and access to AI and automated technologies to be a strong and effective cop on the beat,” said Martina Rejsjö, head of Nasdaq Surveillance North America Equities.

Nasdaq, a tech-driven trading platform, has an associated regulatory body that offers over 40 different algorithms, using 35,000 parameters, to spot possible market abuse and manipulation in real time. “The massive and, in many cases, exponential growth in market data is a significant challenge for surveillance professionals," Rejsjö said. “Market abuse attempts have become more sophisticated, putting more pressure on surveillance teams to find the proverbial needle in the data haystack." In layman's terms, she believes that the future is in tech overseeing trading activities, as the human eye is unable to keep up with the rapid-fire, sophisticated global trading dominated by algorithms.

When people say not to worry, that’s the precise time to worry. Companies—whether they are McDonald’s, introducing self-serve kiosks and firing hourly workers to cut costs, or top-tier investment banks that rely on software instead of traders to make million-dollar bets on the stock market—will continue to implement technology and downsize people in an effort to enhance profits and cut down on expenses. This trend will be hard to stop and have serious future consequences for the workers at all levels and salaries. 

The info is here.

Sunday, July 14, 2019

The Voluntariness of Voluntary Consent: Consent Searches and the Psychology of Compliance

Sommers, Roseanna and Bohns, Vanessa K.
Yale Law Journal, Vol. 128, No. 7, 2019. 
Available at SSRN: https://ssrn.com/abstract=3369844

Abstract

Consent-based searches are by far the most ubiquitous form of search undertaken by police. A key legal inquiry in these cases is whether consent was granted voluntarily. This Essay suggests that fact finders’ assessments of voluntariness are likely to be impaired by a systematic bias in social perception. Fact finders are likely to under appreciate the degree to which suspects feel pressure to comply with police officers’ requests to perform searches.

In two preregistered laboratory studies, we approached a total of 209 participants (“Experiencers”) with a highly intrusive request: to unlock their password-protected smartphones and hand them over to an experimenter to search through while they waited in another room. A separate 194 participants (“Forecasters”) were brought into the lab and asked whether a reasonable person would agree to the same request if hypothetically approached by the same researcher. Both groups then reported how free they felt, or would feel, to refuse the request.

Study 1 found that whereas most Forecasters believed a reasonable person would refuse the experimenter’s request, most Experiencers — 100 out of 103 people — promptly unlocked their phones and handed them over. Moreover, Experiencers reported feeling significantly less free to refuse than did Forecasters contemplating the same situation hypothetically.

Study 2 tested an intervention modeled after a commonly proposed reform of consent searches, in which the experimenter explicitly advises participants that they have the right to with- hold consent. We found that this advisory did not significantly reduce compliance rates or make Experiencers feel more free to say no. At the same time, the gap between Experiencers and Forecasters remained significant.

These findings suggest that decision makers judging the voluntariness of consent consistently underestimate the pressure to comply with intrusive requests. This is problematic because it indicates that a key justification for suspicionless consent searches — that they are voluntary — relies on an assessment that is subject to bias. The results thus provide support to critics who would like to see consent searches banned or curtailed, as they have been in several states.

The results also suggest that a popular reform proposal — requiring police to advise citizens of their right to refuse consent — may have little effect. This corroborates previous observational studies, which find negligible effects of Miranda warnings on confession rates among interrogees, and little change in rates of consent once police start notifying motorists of their right to refuse vehicle searches. We suggest that these warnings are ineffective because they fail to address the psychology of compliance. The reason people comply with police, we contend, is social, not informational. The social demands of police-citizen interactions persist even when people are informed of their rights. It is time to abandon the myth that notifying people of their rights makes them feel empowered to exercise those rights.

Tuesday, June 4, 2019

What's The Difference Between Compliance And Ethics?

Bruce Weinstein
GettyForbes.com
Originally posted May 9, 2019

I've noticed some confusion about the roles that ethics and compliance play in organizations. This confusion arises, in part, from the way these two fields are identified. Some companies have only a compliance department. Others have a compliance and ethics (or ethics and compliance) department. Some companies have a Chief Ethics Officer separate from compliance.

To get some clarity on these crucial roles, I asked seven leaders who are involved in both ethics and compliance to explain the similarities and differences as they saw them. I'll present their views, offer my own analysis and then consider what this means for your career and your organization.

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The Takeaways

What does all of this mean for you?

  1. If you're in compliance and/or ethics, it's worth having a clear understanding of what each department or program is about, how they're similar and how they differ. Then make sure that everyone in the organization understands these similarities and differences and what this means for their own roles.
  2. If you're not in compliance or ethics, find out how the company defines each area and what this means for you. Whether you want to move up in the organization or simply remain gainfully employed there, you will put yourself in good stead if you know the difference between ethics and compliance as your company defines them.
  3. No matter how your company views compliance and ethics, what its code of conduct is or whether you work within or outside of the compliance and ethics programs, it's not enough to ask, "What do laws, regulations or policies require of me?" The follow-up question should always be, "What is the right thing to do?"

Monday, May 27, 2019

How To Prevent AI Ethics Councils From Failing

uncaptionedManoj Saxena
www.forbes.com
Originally posted April 30, 2019

There's nothing “artificial” about Artificial Intelligence-infused systems. These systems are real and are already impacting everyone today though automated predictions and decisions. However, these digital brains may demonstrate unpredictable behaviors that can be disruptive, confusing, offensive, and even dangerous. Therefore, before getting started with an AI strategy, it’s critical for companies to consider AI through the lens of building systems you can trust.

Educate on the criticality of a ‘people and ethics first’ approach

AI systems often function in oblique, invisible ways that may harm the most vulnerable. Examples of such harm include loss of privacy, discrimination, loss of skills, economic impact, the security of critical infrastructure, and long-term effects on social well-being.

The ‘’technology and monetization first approach’’ to AI needs to evolve to a “people and ethics first” approach. Ethically aligned design is a set of societal and policy guidelines for the development of intelligent and autonomous systems to ensure such systems serve humanity’s values and ethical principles.

Multiple noteworthy organizations and countries have proposed guidelines for developing trusted AI systems going forward. These include the IEEE, World Economic Forum, the Future of Life Institute, Alan Turing Institute, AI Global, and the Government of Canada. Once you have your guidelines in place, you can then start educating everyone internally and externally about the promise and perils of AI and the need for an AI ethics council.

The info is here.

Wednesday, April 17, 2019

A New Model For AI Ethics In R&D

Forbes Insight Team
Forbes.com
Originally posted March 27, 2019

Here is an excerpt:

The traditional ethics oversight and compliance model has two major problems, whether it is used in biomedical research or in AI. First, a list of guiding principles—whether four or 40—just summarizes important ethical concerns without resolving the conflicts between them.

Say, for example, that the development of a life-saving AI diagnostic tool requires access to large sets of personal data. The principle of respecting autonomy—that is, respecting every individual’s rational, informed, and voluntary decision making about herself and her life—would demand consent for using that data. But the principle of beneficence—that is, doing good—would require that this tool be developed as quickly as possible to help those who are suffering, even if this means neglecting consent. Any board relying solely on these principles for guidance will inevitably face an ethical conflict, because no hierarchy ranks these principles.

Second, decisions handed down by these boards are problematic in themselves. Ethics boards are far removed from researchers, acting as all-powerful decision-makers. Once ethics boards make a decision, typically no appeals process exists and no other authority can validate their decision. Without effective guiding principles and appropriate due process, this model uses ethics boards to police researchers. It implies that researchers cannot be trusted and it focuses solely on blocking what the boards consider to be unethical.

We can develop a better model for AI ethics, one in which ethics complements and enhances research and development and where researchers are trusted collaborators with ethicists. This requires shifting our focus from principles and boards to ethical reasoning and teamwork, from ethics policing to ethics integration.

The info is here.

Monday, November 12, 2018

7 Ways Marketers Can Use Corporate Morality to Prepare for Future Data Privacy Laws

Patrick Hogan
Adweek.com
Originally posted October 10, 2018

Here is an excerpt:

Many organizations have already made responsible adjustments in how they communicate with users about data collection and use and have become compliant to support recent laws. However, compliance does not always equal responsibility, and even though companies do require consent and provide information as required, linking to the terms of use, clicking a checkbox or double opting-in still may not be enough to stay ahead or protect consumers.

The best way to reduce the impact of the potential legislation is to take proactive steps now that set a new standard of responsibility in data use for your organization. Below are some measurable ways marketers can lead the way for the changing industry and creating a foundational perception shift away from data and back to the acknowledgment of putting other humans first.

Create an action plan for complete data control and transparency

Set standards and protocols for your internal teams to determine how you are going to communicate with each other and your clients about data privacy, thus creating a path for all employees to follow and abide by moving forward.

Map data in your organization from receipt to storage to expulsion

Accountability is key. As a business, you should be able to know and speak to what is being done with the data that you are collecting throughout each stage of the process.

The info is here.

Thursday, October 11, 2018

Does your nonprofit have a code of ethics that works?

Mary Beth West
USA Today Network - Tennessee
Originally posted September 10, 2018

Each year, the Public Relations Society of America recognizes September as ethics month.

Our present #FakeNews / #MeToo era offers a daily diet of news coverage and exposés about ethics shortfalls in business, media and government sectors.

One arena sometimes overlooked is that of nonprofit organizations.

I am currently involved in a national ethics-driven bylaw reform movement for PRSA itself, which is a 501(c)(6) nonprofit with 21,000-plus members globally, in the “business league” category.

While PRSA’s code of ethics has stood for decades as an industry standard for communications ethics – promoting members’ adherence to only truthful and honest practices – PRSA’s code is not enforceable.

Challenges with unenforced ethics codes

Unenforced codes of ethics are commonplace in the nonprofit arena, particularly for volunteer, member-driven organizations.

PRSA converted from its enforced code of ethics to one that is unenforced by design, nearly two decades ago.

The reason: enforcing code compliance and the adjudication processes inherent to it were a pain in the neck (and a pain in the wallet, due to litigation risks).

The info is here.

Wednesday, May 9, 2018

Getting Ethics Training Right for Leaders and Employees

Deloitte
The Wall Street Journal
Originally posted April 9, 2018

Here is an excerpt:

Ethics training has needed a serious redesign for some time, and we are seeing three changes to make training more effective. First, many organizations recognize that compliance training is not enough. Simply knowing the rules and how to call the ethics helpline does not necessarily mean employees will raise their voice when they see ethical issues in the workplace. Even if employees want to say something they often hesitate, worried that they may not be heard, or even worse, that voicing may lead to formal or informal retaliation. Overcoming this hesitation requires training to help employees learn how to voice their values with in-person, experiential practice in everyday workplace situations. More and more organizations are investing in this training, as a way to simultaneously support employees, reduce risk and proactively reshape their culture.

Another significant change in ethics training is a focus on helping senior leaders consider how their own ethical leadership shapes the culture. This requires leaders to examine the signals they send in their everyday behaviors, and how these signals make employees feel safe to voice ideas and concerns. In my training sessions with senior leaders, we use exercises that help them identify the leadership behaviors that create such trust, and those that may be counter-productive. We then redesign the everyday processes, such as the weekly meeting or decision-making models, that encourage voice and explicitly elevate ethical concerns.

Third, more organizations are seeing the connection between ethics and greater sense of purpose in the workplace. Employee engagement, performance and retention often increases when employees feel they are contributing something beyond profit creation. Ethics training can help employees see this connection and practice the so-called giver strategies that help others, their organizations, and their own careers at the same time.

The article is here.

Thursday, March 29, 2018

Government watchdog files 30 ethics complaints against Trump administration

Julia Manchester
The Hill
Originally posted March 26, 2018

Here is an excerpt:

"The bottom line is that neither Trump nor his administration take conflicts of interest and ethics seriously," Lisa Gilbert, the group's vice president of legislative affairs, told the network.

" 'Drain the swamp' was far more campaign rhetoric than a commitment to ethics, and the widespread lack of compliance and enforcement of Trump's ethics executive order shows that ethics do not matter in the Trump administration."

NBC News reports Public Citizen filed complaints with the White House Office of Management and Budget, the Environmental Protection Agency, and the departments of Defense, Homeland Security, Housing and Urban Development, Transportation, Health and Human Services, Commerce and Interior, among others.

Trump signed an executive order shortly after he took office in 2017 that was aimed at cracking down on lobbyists' influence in the U.S. government.

The order allowed officials who departed the administration to lobby the government, except the agency for which they worked, and permitted lobbyists to enter the administration as long as they didn't work on specific issues that would impact former clients or employers for two years.

The article is here.

Tuesday, March 20, 2018

The Psychology of Clinical Decision Making: Implications for Medication Use

Jerry Avorn
February 22, 2018
N Engl J Med 2018; 378:689-691

Here is an excerpt:

The key problem is medicine’s ongoing assumption that clinicians and patients are, in general, rational decision makers. In reality, we are all influenced by seemingly irrational preferences in making choices about reward, risk, time, and trade-offs that are quite different from what would be predicted by bloodless, if precise, quantitative calculations. Although we physicians sometimes resist the syllogism, if all humans are prone to irrational decision making, and all clinicians are human, then these insights must have important implications for patient care and health policy. There have been some isolated innovative applications of that understanding in medicine, but despite a growing number of publications about the psychology of decision making, most medical care — at the bedside and the systems level — is still based on a “rational actor” understanding of how we make decisions.

The choices we make about prescription drugs provide one example of how much further medicine could go in taking advantage of a more nuanced understanding of decision making under conditions of uncertainty — a description that could define the profession itself. We persist in assuming that clinicians can obtain comprehensive information about the comparative worth (clinical as well as economic) of alternative drug choices for a given condition, assimilate and evaluate all the findings, and synthesize them to make the best drug choices for our patients. Leaving aside the access problem — the necessary comparative effectiveness research often doesn’t exist — actual drug-utilization data make it clear that real-world prescribing choices are in fact based heavily on various “irrational” biases, many of which have been described by behavioral economists and other decision theorists.

The article is here.

Saturday, March 3, 2018

Why It's OK Behavioral Economics Failed To Prevent Heart Attacks

Peter Ubel
Forbes.com
Originally published January 31, 2018

Here are two excerpts:

To increase the chance people will take these important pills, a team out of the University of Pennsylvania created a behavioral economic incentive. The intervention was multipronged. It included enrolling patients in lotteries, which gave them a chance to win money every day they took their pills. It encouraged patients to enlist a friend to help them stay on track taking their pills, a friend who would get notified every time they skipped their medications for a few days in a row.

But the intervention failed — it neither increased adherence to medications nor reduced hospitalizations for heart attacks. These results are shown in the figure below, which, despite appearances, shows two lines, representing the intervention group and the control group, respectively; the lines practically merge into one...

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Sometimes behavioral economics is criticized for being over-hyped, for being touted as the answer to all our behavioral problems. I’ve been one of those critics. But my beef isn’t with behavioral economists — my research frequently draws upon insights from that field. My issue is with people who think of behavioral economics as some kind of magic wand we can wave over stubbornly harmful behavior. Changing people’s behavior is hard to do, especially without resorting to draconian measures.

We need to keep experimenting with ways to help people take care of their health.

The article is here.

Wednesday, November 29, 2017

The Hype of Virtual Medicine

Ezekiel J. Emanuel
The Wall Street Journal
Originally posted Nov. 10, 2017

Here is an excerpt:

But none of this will have much of an effect on the big and unsolved challenge for American medicine: how to change the behavior of patients. According to the Centers for Disease Control and Prevention, fully 86% of all health care spending in the U.S. is for patients with chronic illness—emphysema, arthritis and the like. How are we to make real inroads against these problems? Patients must do far more to monitor their diseases, take their medications consistently and engage with their primary-care physicians and nurses. In the longer term, we need to lower the number of Americans who suffer from these diseases by getting them to change their habits and eat healthier diets, exercise more and avoid smoking.

There is no reason to think that virtual medicine will succeed in inducing most patients to cooperate more with their own care, no matter how ingenious the latest gizmos. Many studies that have tried some high-tech intervention to improve patients’ health have failed.

Consider the problem of patients who do not take their medication properly, leading to higher rates of complications, hospitalization and even mortality. Researchers at Harvard, in collaboration with CVS, published a study in JAMA Internal Medicine in May comparing different low-cost devices for encouraging patients to take their medication as prescribed. The more than 50,000 participants were randomly assigned to one of three options: high-tech pill bottles with digital timer caps, pillboxes with daily compartments or standard plastic pillboxes. The high-tech pill bottles did nothing to increase compliance.

Other efforts have produced similar failures.

The article is here.

Tuesday, November 28, 2017

Don’t Nudge Me: The Limits of Behavioral Economics in Medicine

Aaron E. Carroll
The New York Times - The Upshot
Originally posted November 6, 2017

Here is an excerpt:

But those excited about the potential of behavioral economics should keep in mind the results of a recent study. It pulled out all the stops in trying to get patients who had a heart attack to be more compliant in taking their medication. (Patients’ adherence at such a time is surprisingly low, even though it makes a big difference in outcomes, so this is a major problem.)

Researchers randomly assigned more than 1,500 people to one of two groups. All had recently had heart attacks. One group received the usual care. The other received special electronic pill bottles that monitored patients’ use of medication. Those patients who took their drugs were entered into a lottery in which they had a 20 percent chance to receive $5 and a 1 percent chance to win $50 every day for a year.

That’s not all. The lottery group members could also sign up to have a friend or family member automatically be notified if they didn’t take their pills so that they could receive social support. They were given access to special social work resources. There was even a staff engagement adviser whose specific duty was providing close monitoring and feedback, and who would remind patients about the importance of adherence.

This was a kitchen-sink approach. It involved direct financial incentives, social support nudges, health care system resources and significant clinical management. It failed.

The article is here.

Thursday, November 2, 2017

Culture and Business Ethics

Marshall Schminke
www.ethicalsystems.com
Originally published October 3, 2017

Here is an excerpt:

What do most companies overlook when it comes to organizational design?

Supervisors. Despite some high profile missteps, organizations generally do a pretty good job of making ethics a front-and-center issue at the upper levels.  Likewise, they invest heavily in education and training at the level of the rank-and-file worker.  But as with so many strategically important issues, low-to-mid-level supervisors are often ignored.  This is troublesome, because research shows the single most important factor in driving employees’ ethical actions is not what top managers or coworkers say or do.  Rather, it is the immediate supervisor—and whether he or she is capable of creating an ethically supportive work culture that employees experience every day—that matters most.  Yet in most cases, these “sergeants and lieutenants” of the workplace receive relatively little attention when it comes to ethics and ethics training.

How can E&C teams better emphasize ethics vs. compliance?

Culture. It’s not that rules aren’t important.  They are.  And they must be understood and followed.  But complex business environments—and complex ethical rules and standards—cannot address every situation employees might encounter.  Therefore, the only real insurance organizations have for getting the best ethical effort possible from their employees is to bake it into the culture and climate, where it becomes second nature to employees trying to do their best in a tough business world.

What have you learned as a part of the ES culture measurement working group?

As a culture and climate researcher for years, this experience has been truly eye-opening for me.  It has introduced me to different perspectives on culture and, in turn, exposed me to completely different ways of thinking about how to create and maintain effective ethical cultures.  For example, of the eight components of ethical culture identified by the Ethical Systems culture measurement working group, I had only a passing familiarity with the ethical awareness and ethical leadership components.  This experience has not only improved my understanding of those components, but has also heightened my awareness of how they fit and interact with the other six components.

The information is here.

Tuesday, August 8, 2017

The next big corporate trend? Actually having ethics.

Patrick Quinlan
Recode.net
Originally published July 20, 2017

Here is an excerpt:

Slowly, brands are waking up to the fact that strong ethics and core values are no longer a “nice to have,” but a necessity. Failure to take responsibility in times of crisis can take an irreparable toll on the trust companies have worked so hard to build with employees, partners and customers. So many brands are still getting it wrong, and the consequences are real — public boycotting, massive fines, fired CEOs and falling stock prices.

This shift is what I call ethical transformation — the application of ethics and values across all aspects of business and society. It’s as impactful and critical as digital transformation, the other megatrend of the last 20 years. You can’t have one without the other. The internet stripped away barriers between consumers and brands, meaning that transparency and attention to ethics and values is at an all-time high. Brands have to get on board, now. Consider some oft-cited casualties of the digital transformation: Blockbuster, Kodak and Sears. That same fate awaits companies that can’t or won’t prioritize ethics and values.

This is a good thing. Ethical transformation pushes us into a better future, one built on genuinely ethical companies. But it’s not easy. In fact, it’s pretty hard. And it takes time. For decades, most of the business world focused on what not to do or how not to get fined. (In a word: Compliance.) Every so often, ethics and its even murkier brother “values” got a little love as an afterthought. Brands that did focus on values and ethics were considered exceptions to the rule — the USAAs and Toms shoes of the world. No longer.

The article is here.

Wednesday, March 30, 2016

Doctors Often Fail To Treat Depression Like A Chronic Illness

Shfali Luthra
NPR.org
Originally published March 7, 2016

Depression prompts people to make about 8 million doctors' appointments a year, and more than half are with primary care physicians. A study suggests those doctors often fall short in treating depression because of insurance issues, time constraints and other factors.

More often than not, primary care doctors fail to teach patients how to manage their care and don't follow up to see how they're doing, according to the study, which was published Monday in Health Affairs. Those are considered effective tactics for treating chronic illnesses.

"The approach to depression should be like that of other chronic diseases," said Dr. Harold Pincus, vice chair of psychiatry at Columbia University's College of Physicians and Surgeons and one of the study's co-authors. But "by and large, primary care practices don't have the infrastructure or haven't chosen to implement those practices for depression."

Most people with depression seek help from their primary care doctors, the study notes. That can be because patients often face shortages and limitations of access to specialty mental health care, including lack of insurance coverage, the authors write. Plus there's stigma: Patients sometimes feel nervous or ashamed to see a mental health specialist, according to the authors.

The article is here.