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 Epidemiology. Show all posts
Showing posts with label Epidemiology. Show all posts

Saturday, December 5, 2020

The epidemiology of moral bioenhancement

R. B. Gibson
Medicine, Health Care and Philosophy 
https://doi.org/10.1007/s11019-020-09980-1

Abstract 

In their 2008 paper, Persson and Savulescu suggest that for moral bioenhancement (MBE) to be effective at eliminating the danger of ‘ultimate harm’ the intervention would need to be compulsory. This is because those most in need of MBE would be least likely to undergo the intervention voluntarily. By drawing on concepts and theories from epidemiology, this paper will suggest that MBE may not need to be universal and compulsory to be effective at significantly improving the collective moral standing of a human populace and reducing the threat of ultimate harm. It will identify similarities between the mechanisms that allow biological contagions (such as a virus) and behaviours (such as those concerned with ethical and unethical actions) to develop, spread, and be reinforced within a population. It will then go onto suggest that, just as with the epidemiological principle of herd immunity, if enough people underwent MBE to reach a minimum threshold then the incidence and spread of immoral behaviours could be significantly reduced, even in those who have not received MBE.

Conclusion 

The phenomenon of herd immunity is one that is critical in the field of vaccine epidemiology and public health. Once it takes effect, even those individuals who are unable to undergo vaccination are still able to benefit from a functional immunity from a biological agent. As such, a compulsory and universal programme of vaccination is not always necessary to achieve a sufficient protection rate against a contagious biological agent. It is this same line of reasoning which this paper has sought to employ, envisioning MBE as a form of vaccination against those types of behaviour that would lead to the realisation of UH (Ultimate Harm). Consequentially, this allows for the possibility of sufficient protection against the undesirable behaviours that would lead to UH without a need for a universal and compulsory enhancement programme.

Thursday, August 13, 2020

Every Decision Is A Risk. Every Risk Is A Decision.

Maggie Koerth
fivethirtyeight.com
Originally posted 21 July 20

Here is an excerpt:

In general, research has shown that indoors is riskier than outside, long visits riskier than short ones, crowds riskier than individuals — and, look, just avoid situations where you’re being sneezed, yelled, coughed or sung at.

But the trouble with the muddy middle is that a general idea of what is riskier isn’t the same thing as a clear delineation between right and wrong. These charts — even the best ones — aren’t absolute arbiters of safety: They’re the result of surveying experts. In the case of Popescu’s chart, the risk categorizations were assigned based on discussions among herself, Emanuel and Dr. James P. Phillips, the chief of disaster medicine at George Washington University Emergency Medicine. They each independently assigned a risk level to each activity, and then hashed out the ones on which they disagreed.

Take golf. How safe is it to go out to the links? Initially, the three experts had different risk levels assigned to this activity because they were all making different assumptions about what a game of golf naturally involved, Popescu said. “Are people doing it alone? If not, how many people are in a cart? Are they wearing masks? Are they drinking? …. those little variables that can increase the risk,” she told me.

Golf isn’t just golf. It’s how you golf that matters.

Those variables and assumptions aren’t trivial to calculating risk. Nor are they static. There’s different muck under your boggy feet in different parts of the country, at different times. For instance, how safe is it to eat outdoors with friends? Popescu’s chart ranks “outdoor picnic or porch dining” with people outside your household as low risk — a very validating categorization, personally. But a chart produced by the Texas Medical Association, based on a survey of its 53,000 physician members, rates “attending a backyard barbeque” as a moderate risk, a 5 on a scale in which 9 is the stuff most of us have no problem eschewing.

The info is here.

Saturday, July 18, 2020

Making Decisions in a COVID-19 World

Baruch Fischoff
JAMA. 2020;324(2):139-140.
doi:10.1001/jama.2020.10178

Here are two excerpts:

Individuals must answer complementary questions. When is it safe enough to visit a physician’s office, get a dental check-up, shop for clothing, ride the bus, visit an aging or incarcerated relative, or go to the gym? What does it mean that some places are open but not others and in one state, but not in a bordering one? How do individuals make sense of conflicting advice about face masks, fomites, and foodstuffs?

Risk analysis translates technical knowledge into terms that people can use. Done to a publication standard, risk analysis requires advanced training and substantial resources. However, even back-of-the-envelope calculations can help individuals make sense of otherwise bewildering choices. Combined with behavioral research, risk analysis can help explain why reasonable people sometimes make different decisions. Why do some people wear face masks and crowd on the beach, while others do not? Do they perceive the risks differently or are they concerned about different risks?

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Second, risk analyses are needed to apply that knowledge. However solid the science on basic physical, biological, and behavioral processes, applying it requires knowledge of specific settings. How do air and people circulate? What objects and surfaces do people and viruses touch? How sustainable are physical barriers and behavioral practices? Risk analysts derive such estimates by consulting with scientists who know the processes and decision makers who know the settings.3 Boundary organizations are needed to bring the relevant parties together in each sector (medicine, sports, schools, movie production, etc) to produce estimates informed by the science and by people who know how that sector works.

The info is here.

Friday, May 12, 2017

US Suicide Rates Display Growing Geographic Disparity.

JAMA.
2017;317(16):1616. doi:10.1001/jama.2017.4076

As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced.

Using data from the National Vital Statistics System and the US Census Bureau, the researchers reported that from 1999 to 2015, the annual suicide rate increased by 14%, from 12.6 to 14.4 per 100, 000 US residents aged 10 years or older.

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Higher suicide rates in less urban areas could be linked with limited access to mental health care, the opioid overdose epidemic, and social isolation, the investigators suggested. The 2007-2009 economic recession may have caused the sharp upswing, they added, because rural areas and small towns were hardest hit.

The article is here

Thursday, October 27, 2016

Sex and Other Sins: Public Morality, Public Health, and Funding PrEP

Guest Post by Nathan Emmerich
BMJ Blogs
Originally posted October 5, 2016

Here is an excerpt:

Consider the following thought experiments. Imagine a drug that could be taken to significantly lessen the risk that a smoker would develop lung cancer, or a drug that would lessen the risk of ‘at risk’ individuals developing diabetes. In such cases would we be inclined to refuse public funds for such drugs merely because such individuals could lessen their risks even more by giving up smoking, or by losing weight and eating a healthy or, at least, healthier diet?

There is, certainly, something regrettable about having to spend public money on a drug that offsets risks generated by an individual’s own behaviour. Nevertheless, from an epidemiological – and therefore public health – perspective, the notion that an individual makes a choice about whether or not to smoke, or to have a bad diet, is too simplistic, even when we place the issue of addiction to one side. Thus, even when smoking cessation programmes are available and even when nutritional advice is within easy reach (as it increasingly is), plenty of people still smoke and consume a less than healthy diet.

Smoking and bad diets are correlated with a variety of demographic factors, and our choices are always made within particular cultural and socio-political contexts. Even so, some have questioned if the NHS should be funding stomach-stapling operations for those who are overweight, or if smokers and non-smokers can expect to receive the same level of treatment and care.

The entire blog post is here.

Monday, September 5, 2016

Are There Still Too Few Suicides to Generate Public Outrage?

Lytle MC, Silenzio VB, Caine ED.
JAMA Psychiatry. Published online August 17, 2016.
doi:10.1001/jamapsychiatry.2016.1736.

Suicide is the 10th leading cause of death in the United States, with the overall rate increasing 28.2% since 1999, driven by a 35.3% increase in suicides among persons 35 to 64 years of age.1 Suicides surpassed road traffic deaths in 2009, and the 42 773 suicides reported were more than double the 16 324 homicides in 2014. When coupled with deaths from other deliberate behaviors, research suggests that the mortality from self-directed injury exceeds 70 000 lives, making it the eighth leading cause of death while the death rates of cardiovascular diseases (CVDs), cancers, and human immunodeficiency virus (HIV)/AIDS continue to decrease.

The entire piece is here.

Wednesday, January 6, 2016

Mental Health Reform Will Not Reduce US Gun Violence, Experts Say

Rita Rubin
JAMA.
Published online December 16, 2015. doi:10.1001/jama.2015.16421

Here is an excerpt:

But while few people would disagree with the need for mental health reform, scientists who study gun violence say it won’t make much of a dent in the number of homicides and attempted homicides committed with firearms. That’s because although mass shooters are likely to be mentally ill (but not necessarily diagnosed), high-profile mass shootings represent only a small fraction of US gun violence, the vast majority of which is committed by people who are not mentally ill. In addition, most people with mental illness are not violent; they are far more likely to be the victims than the perpetrators of shootings.

People should realize that “even though it feels that mass shootings happen all the time, they’re still extremely rare,” said Jeffrey Swanson, PhD, a professor of psychiatry and behavioral sciences at Duke University.

Through early December 2015, about 450 individuals died in mass shootings in the United States last year, according to Mass Shooting Tracker, a crowd-sourced website that defines a mass shooting as one in which at least 4 people have been shot but not necessarily killed (http://bit.ly/1MuHpVL). Compare that with 11 208, the number of people killed in homicides committed with firearms in 2013, the most recent year for which the Centers for Disease Control and Prevention (CDC) has US data (http://1.usa.gov/1GEJ0TN).

The entire article is here.

Tuesday, December 22, 2015

Is Gun Violence a Public Health Crisis?

Science Friday Podcast
Ira Flatow is the Host and Executive Producer

On Wednesday, a mass shooting in San Bernardino, California left 14 people dead, making it one of the deadliest in modern American history. In fact, there have been more mass shootings than there have been days in 2015 so far. Of course, gun violence in the United States isn’t restricted to mass shootings—firearm homicides and suicides far outpace the number of mass-shooting fatalities. Taken together, an estimated 32,000 people die as a result of gun violence in the United States annually, and an additional 180,000 to 190,000 people are injured, says Sandro Galea. He’s the dean of Boston University’s School of Public Health and one of a number of researchers calling for firearm deaths to be treated as a public health issue. Another is Garen Wintemute, of the UC Davis School of Medicine, who has done extensive research on the effects of access to guns. Wintemute and Galea join Ira to discuss why they see gun violence as a public health issue and what research must be done and steps taken to address the problem.

The podcast is here.

Thursday, October 8, 2015

Self-injury Is the Eighth Leading Cause of Death in the United States

By Ian R. H. Rockett and Eric D. Caine
JAMA Psychiatry. Published online September 16, 2015.

This Viewpoint discusses the false dichotomy of separating suicides from fatal self-injurious acts that are labeled “accidents” or “unintentional” deaths.

Establishing a person’s intention to die has been a central element separating suicides from fatal self-injurious acts that are labeled “accidents” or “unintentional” deaths. We argue that this is a false dichotomy—certainly at the level of populations—that masks the overall magnitude of fatalities arising from deliberate, self-destructive behaviors. In so doing, it mutes the urgency for demanding effective preventive interventions and is particularly problematic as the nation experiences a persisting and growing epidemic of opioid and other drug-poisoning deaths. Firearm trauma and hanging/asphyxiation, the leading methods of suicide, typically generate ample forensic evidence for assuring accurate determinations by medical examiners and coroners. However, corroborative evidence is less available for poisoning, the third leading method of suicide overall, and first among women. Parenthetically, we acknowledge that the Centers for Disease Control and Prevention use “unintentional injury" in lieu of the term accident for surveillance and prevention purposes. However, medical examiners and coroners remain bound by statutes in using “accident” as 1 of 6 manner-of-death entries (homicide, suicide, accident, undetermined, natural causes, and unknown) that alternatively appear on death certificates.

The entire article is here.

Monday, March 9, 2015

Modelling suicide and unemployment: a longitudinal analysis

Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000–11
Nordt, Carlos et al.
The Lancet Psychiatry
DOI: http://dx.doi.org/10.1016/S2215-0366(14)00118-7

Summary

Background

As with previous economic downturns, there has been debate about an association between the 2008 economic crisis, rising unemployment, and suicide. Unemployment directly affects individuals' health and, unsurprisingly, studies have proposed an association between unemployment and suicide. However, a statistical model examining the relationship between unemployment and suicide by considering specific time trends among age-sex-country subgroups over wider world regions is still lacking. We aimed to enhance knowledge of the specific effect of unemployment on suicide by analysing global public data classified according to world regions.

Methods

We retrospectively analysed public data for suicide, population, and economy from the WHO mortality database and the International Monetary Fund's world economic outlook database from 2000 to 2011. We selected 63 countries based on sample size and completeness of the respective data and extracted the information about four age groups and sex. To check stability of findings, we conducted an overall random coefficient model including all study countries and four additional models, each covering a different world region.

Findings

Despite differences in the four world regions, the overall model, adjusted for the unemployment rate, showed that the annual relative risk of suicide decreased by 1·1% (95% CI 0·8–1·4) per year between 2000 and 2011. The best and most stable final model indicated that a higher suicide rate preceded a rise in unemployment (lagged by 6 months) and that the effect was non-linear with higher effects for lower baseline unemployment rates. In all world regions, the relative risk of suicide associated with unemployment was elevated by about 20–30% during the study period. Overall, 41 148 (95% CI 39 552–42 744) suicides were associated with unemployment in 2007 and 46 131 (44 292–47 970) in 2009, indicating 4983 excess suicides since the economic crisis in 2008.

Interpretation

Suicides associated with unemployment totalled a nine-fold higher number of deaths than excess suicides attributed to the most recent economic crisis. Prevention strategies focused on the unemployed and on employment and its conditions are necessary not only in difficult times but also in times of stable economy.

Monday, November 24, 2014

More action sought to stop suicide in Canada

Suicide’s death toll exceeds homicide, and car accidents combined: the equivalent of ‘20 jumbo jets just disappearing.’

By Olivia Carville
The Star
Originally published on November 3, 2014

Every year, more Canadians kill themselves than die by car accidents, HIV, homicide, drowning, influenza and war combined.

In Ontario alone, the suicide rate doubles the road toll most years, figures obtained from the Office of the Chief Coroner show.

Despite this, preventive awareness campaigns and funding for suicide pales in comparison to all other public safety issues, experts told the Star.

The entire story is here.

Monday, November 17, 2014

Suicide surpassed war as the military's leading cause of death

By Gregg Zoroya
USA Today
Originally published October 31, 2014

War was the leading cause of death in the military nearly every year between 2004 and 2011 until suicides became the top means of dying for troops in 2012 and 2013, according to a bar chart published this week in a monthly Pentagon medical statistical analysis journal.

The entire article is here.

Tuesday, August 5, 2014

Foreclosures Drive up Suicide Rate

Press Release
Originally released May 18, 2014

The recent U.S. foreclosure crisis contributed significantly to the nation’s jump in suicides, independent of other economic factors associated with the Great Recession, according to a new study by Dartmouth and Purdue University professors.

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“It seems that foreclosures affect suicide rates in two ways,” says co-author Jason Houle, an assistant professor of sociology at Dartmouth. “The loss of a home clearly impacts individuals and families, and can arouse feelings of loss, shame or regret. At the same time, rising foreclosure rates affect entire communities because they’re associated with a number of community-level resources and stresses, including an increase in crime, abandoned homes, and a sense of insecurity.”

The entire press release is here.

Jason N. Houle and Michael T. Light.  The Home Foreclosure Crisis and Rising Suicide Rates, 2005 to 2010. American Journal of Public Health: June 2014, Vol. 104, No. 6, pp. 1073-1079.
doi: 10.2105/AJPH.2013.301774

Thursday, July 3, 2014

Recession Linked to More Than 10,000 Suicides in North America, Europe

By Mary Elizabeth Dallas
MedicineNet.com
Originally published June 12, 2014

The Great Recession that began in 2007 appears to have taken more than a financial toll: New research suggests that the economic downturn could be linked with more than 10,000 suicides across North America and Europe.

The study found that between 2008 and 2010, rates of suicide surged in the European Union, Canada and the United States. The increase was four times higher among men than women, according to the report published in the current issue of the British Journal of Psychiatry.

The entire article is here.

Tuesday, May 6, 2014

Record numbers on 'happy pills'

Psychiatrists warning over soaring use of pills in 'depressed Britain'

By Laura Donnelley
The Telegraph
Originally posted April 20, 2014

Britons are taking anti-depressants in greater quantities than ever before, new figures have disclosed, with a near 25 per cent rise in prescriptions in the last three years alone.

According to official NHS data, more than 53 million prescriptions were handed out for drugs such as Prozac and Seroxat in England last year - a record high, and a rise of 24.6 per cent since 2010.

The entire story is here.

Saturday, April 19, 2014

Wall Street Is Not a Death Trap

By Sally L. Satel
Bloomberg News
Originally posted March 31, 2014

After the suicides of eight people in the global financial sector over six months, investment banks have come under pressure to pay more attention to the mental health of their employees. The high-stress, competitive environment -- with its unpredictably punishing workweeks -- are seen as creating the conditions for pushing some people over the edge.

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In answer to the question raised in a recent Fortune magazine article, no, there isn't a suicide contagion on Wall Street. Rather, the handful of suicides, tragic as each one is, involved the segment of the population most at risk: white men, particularly over 50.

The entire article is here.

Friday, January 10, 2014

America Has an Incest Problem

By Mia Fontaine
The Atlantic
Originally posted January 24, 2013

Here is an excerpt:

Here are some statistics that should be familiar to us all, but aren't, either because they're too mind-boggling to be absorbed easily, or because they're not publicized enough. One in three-to-four girls, and one in five-to-seven boys are sexually abused before they turn 18, an overwhelming incidence of which happens within the family. These statistics are well known among industry professionals, who are often quick to add, "and this is a notoriously underreported crime."

Incest is a subject that makes people recoil. The word alone causes many to squirm, and it's telling that of all of the individual and groups of perpetrators who've made national headlines to date, virtually none have been related to their victims. They've been trusted or fatherly figures (some in a more literal sense than others) from institutions close to home, but not actual fathers, step-fathers, uncles, grandfathers, brothers, or cousins (or mothers and female relatives, for that matter). While all abuse is traumatizing, people outside of a child's home and family—the Sanduskys, the teachers and the priests—account for far fewer cases of child sexual abuse.

The entire article is here.

Monday, December 30, 2013

The Selling of ADHD

By Alan Schwarz
The New York Times
Originally posted December 14, 2013


Here is an excerpt:

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

The entire story is here.

Saturday, November 9, 2013

Suicide Rate Climbs by 30 Percent in Kansas as Government Slashes Mental Health Budgets

Allison Kilkenny on October 21, 2013
The Nation

The Kansas Department of Health and Environment recently released a startling report (PDF) showing a 30 percent increase in suicides from 2011. Nationwide, the number of deaths by suicide surpassed the number of deaths by motor vehicle accidents in 2009, the most recent year for which the Centers for Disease Control and Prevention provided data.

The Wichita Eagle reports that the largest increase in suicides in Kansas occurred among white males, who already were the segment of the population most likely to take their own lives. More than 80 percent of suicides in Kansas last year were men, like Scott Dennis, a 42-year-old fitness company owner.



Friday, May 31, 2013

1 in 5 U.S. Kids Has a Mental Health Disorder: CDC

By Brenda Goodman
HealthDay Reporter
Originally published May 16, 2013

As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.

Released Thursday, the report represents the government's first comprehensive look at mental disorders in children. It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioral or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.

The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent -- about one in 15 children -- in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.

The entire story is here.