The Argument Over a Long-Standing Autism Intervention

Jessica Winter

The New Yorker

Originally posted 12 Feb 24

Here are excerpts:

A.B.A. is the only autism intervention that is approved by insurers and Medicaid in all fifty states. The practice is widely recommended for autistic kids who exhibit dangerous behaviors, such as self-injury or aggression toward others, or who need to acquire basic skills, such as dressing themselves or going to the bathroom. The mother of a boy with severe autism in New York City told me that her son’s current goals in A.B.A. include tolerating the shower for incrementally longer intervals, redirecting the urge to pull on other people’s hair, and using a speech tablet to say no. Another kid might be working on more complex language skills by drilling with flash cards or honing his ability to focus on academic work. Often, A.B.A. targets autistic traits that may be socially stigmatizing but are harmless unto themselves, such as fidgeting, avoiding eye contact, or stereotypic behaviors commonly known as stimming—rocking, hand-flapping, and so forth.

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In recent years, A.B.A. has come under increasingly vehement criticism from members of the neurodiversity movement, who believe that it cruelly pathologizes autistic behavior. They say that its rewards for compliance are dehumanizing; some compare A.B.A. to conversion therapy. Social-media posts condemning the practice often carry the hashtag #ABAIsAbuse. The message that A.B.A. sends is that “your instinctual way of being is incorrect,” Zoe Gross, the director of advocacy at the nonprofit Autistic Self Advocacy Network, told me. “The goals of A.B.A. therapy—from its inception, but still through today—tend to focus on teaching autistic people to behave like non-autistic people.” But others say this criticism obscures the good work that A.B.A. can do. Alicia Allgood, a board-certified behavior analyst who co-runs an A.B.A. agency in New York City, and who is herself autistic, told me, “The autistic community is up in arms. There is a very vocal part of the autistic population that is saying that A.B.A. is harmful or aversive or has potentially caused trauma.”

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In recent years, private equity has taken a voracious interest in A.B.A. services, partly because they are perceived as inexpensive. Private-equity firms have consolidated many small clinics into larger chains, where providers are often saddled with unrealistic billing quotas and cut-and-paste treatment plans. Last year, the Center for Economic and Policy Research published a startling report on the subject, which included an account of how Blackstone effectively bankrupted a successful A.B.A. provider and shut down more than a hundred of its treatment sites. Private-equity-owned A.B.A. chains have been accused of fraudulent billing and wage theft; message boards for A.B.A. providers overflow with horror stories about low pay, churn, and burnout. High rates of turnover are acutely damaging to a specialty that relies on familiarity between provider and client. “The idea that we could just franchise A.B.A. providers and anyone could do the work—that was misinformed,” Singer, of the Autism Science Foundation, said.

The info is here.

The motivating effect of monetary over psychological incentives is stronger in WEIRD cultures

Medvedev, D., Davenport, D.et al.

Nat Hum Behav (2024).

https://doi.org/10.1038/s41562-023-01769-5

Abstract

Motivating effortful behaviour is a problem employers, governments and nonprofits face globally. However, most studies on motivation are done in Western, educated, industrialized, rich and democratic (WEIRD) cultures. We compared how hard people in six countries worked in response to monetary incentives versus psychological motivators, such as competing with or helping others. The advantage money had over psychological interventions was larger in the United States and the United Kingdom than in China, India, Mexico and South Africa (N = 8,133). In our last study, we randomly assigned cultural frames through language in bilingual Facebook users in India (N = 2,065). Money increased effort over a psychological treatment by 27% in Hindi and 52% in English. These findings contradict the standard economic intuition that people from poorer countries should be more driven by money. Instead, they suggest that the market mentality of exchanging time and effort for material benefits is most prominent in WEIRD cultures.

The info is here.

The article challenges the assumption that money universally motivates people more than other incentives. It finds that:

• Monetary incentives were more effective than psychological interventions in WEIRD cultures (Western, Educated, Industrialized, Rich, and Democratic), like the US and UK. People in these cultures exerted more effort for money compared to social pressure or helping others.
• In contrast, non-WEIRD cultures like China, India, Mexico, and South Africa showed a smaller advantage for money. In some cases, even social interventions like promoting cooperation were more effective than financial rewards.
• Language can also influence the perceived value of money. In a study with bilingual Indians, those interacting in English (associated with WEIRD cultures) showed a stronger preference for money than those using Hindi.
• These findings suggest that cultural differences play a significant role in how people respond to various motivational tools. Assuming money as the universal motivator, often based on studies conducted in WEIRD cultures, might be inaccurate and less effective in diverse settings.

Mental Illness Is Not in Your Head

Marco Ramos

Boston Review

Originally posted 17 MAY 22

Here are two excerpts:

In Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, Anne Harrington argues that the current crisis is just the latest in a long line of failures to discover the biology of mental illness over the last two centuries. In this sweeping study, the history of psychiatry undulates like the boom and bust of a speculative market. First a wave builds with enthusiastic promises of revolutionary breakthroughs that will change psychiatry as we know it. Then the wave collapses, as psychiatrists fail to deliver on those bold promises. Crisis ensues, and after the requisite finger-pointing, the next wave of psychiatric revolution begins to build. Rinse and repeat.

The first “revolution” in American psychiatry that Harrington tracks arrived in the nineteenth century. At the time, large lunatic asylums dominated the psychiatric landscape, such as the Blackwell’s Island hospital on what today is called Roosevelt Island in New York City. These institutions were designed to cure patients with mental disorders by placing them in the hospitable environment of the asylum architectural space. However, a series of journalistic exposés revealed that these asylums were overcrowded and underfunded with patients living in deplorable, instead of therapeutic, conditions. For example, in 1887, journalist Elizabeth Seaman, who wrote under the pen name Nellie Bly, went undercover as a patient in Blackwell’s Island Hospital and exposed horrible acts of brutality in her best-seller Ten Days in a Mad-House. Asylum psychiatry faced a crisis of public trust.

As Harrington explains, European neuroanatomists came to the rescue. Unlike asylum physicians, anatomists were pessimistic about the potential for a cure. Building on eugenic theories, they believed that asylum patients were “degenerates” who were biologically unfit to cope with the stresses of modern life. But they also believed that the mentally ill could provide a service to society after their deaths by offering their brains to science. The dissection of their pathological brains, the anatomists hoped, could reveal the biological causes of mental suffering.

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But if the pharmaceutical industry has invested so heavily in psychiatry, why have there been no breakthroughs in drug treatment? A major reason is that the industry has spent billions of dollars more on advertising psychiatric medications than on research and development of novel drugs. As psychiatrist David Healy has shown, money earmarked for R&D is often not intended to produce genuine innovation. Almost all of the psychopharmaceuticals produced since 1990 have been “copycats” that mimic older, generic pharmaceuticals, with only minor chemical modifications. These (unfortunately named) “me-too” drugs work no better clinically than the drugs that came before them, but their slight biochemical novelty means that they can be patented, so that pharma can charge insurance companies’ top dollar.

Perhaps the worst news is that Big Pharma, having created and capitalized on psychiatric markets, is now jumping ship. Anthropologist Joe Dumit has shown that most psychiatric drugs will soon go off patent, so companies will be forced to charge less for them. With the market already saturated with pharmaceutical copycats and no significant scientific biological breakthroughs in sight, there is suddenly little room for growth. Almost all of the major pharmaceutical companies have decided to divest from psychiatric drug research and turn to more promising sectors, especially the development of “biologics” and other cancer drugs.

The info is here.

Universal basic income seems to improve employment and well-being

Donna Lu
New Scientist
Originally post 6 May 20

The world’s most robust study of universal basic income has concluded that it boosts recipients’ mental and financial well-being, as well as modestly improving employment.

Finland ran a two-year universal basic income study in 2017 and 2018, during which the government gave 2000 unemployed people aged between 25 and 58 monthly payments with no strings attached.

The payments of €560 per month weren’t means tested and were unconditional, so they weren’t reduced if an individual got a job or later had a pay rise. The study was nationwide and selected recipients weren’t able to opt out, because the test was written into legislation.

Minna Ylikännö at the Social Insurance Institution of Finland announced the findings in Helsinki today via livestream.

The study compared the employment and well-being of basic income recipients against a control group of 173,000 people who were on unemployment benefits.

Between November 2017 and October 2018, people on basic income worked an average of 78 days, which was six days more than those on unemployment benefits.

There was a greater increase in employment for people in families with children, as well as those whose first language wasn’t Finnish or Swedish – but the researchers aren’t yet sure why.

When surveyed, people who received universal basic income instead of regular unemployment benefits reported better financial well-being, mental health and cognitive functioning, as well as higher levels of confidence in the future.

The info is here.

Government Ethics In The Trump Administration

Scott Simon
Host, Weekend Edition, NPR
Originally posted August 11, 2018

President Trump appointed what's considered the richest Cabinet in U.S. history, and reportedly, more than half of the president's Cabinet, current and former, have been the subject of ethics allegations. There's HUD Secretary Carson's pricey dining table, VA Secretary Shulkin's seats at Wimbledon, Scott Pruitt's housing sublet from a lobbyist, Interior Secretary Zinke's charter planes, Treasury Secretary Mnuchin taking a government plane to see the solar eclipse, and Commerce Secretary Wilbur Ross might need his own category. Forbes magazine reports on many people who have accused him of outright theft, saying - Forbes magazine - quote, "if even half of the accusations are legitimate, the current United States secretary of commerce could rank among the biggest grifters in American history."

The interview is here.

Decriminalizing Mental Illness — The Miami Model

John K. Iglehart
N Engl J Med 2016; 374:1701-1703

Here is an excerpt:

Miami-Dade’s initiative was launched in 2000, when Judge Leifman, frustrated by the fact that people with mental disorders were cycling through his court repeatedly, created the Eleventh Judicial Circuit Criminal Mental Health Project (CMHP). As Leifman explained, “When I became a judge . . . I had no idea I would become the gatekeeper to the largest psychiatric facility in the State of Florida. . . . Of the roughly 100,000 bookings into the [county] jail every year, nearly 20,000 involve people with serious mental illnesses requiring intensive psychiatric treatment while incarcerated. . . . Because community-based delivery systems are often fragmented, difficult to navigate, and slow to respond to critical needs, many individuals with the most severe and disabling forms of mental illnesses . . . fall through the cracks and land in the criminal justice or state hospital systems” that emphasize crisis resolution rather than “promoting ongoing stable recovery and community integration.”

The article is here.

Ethics of Money in Medicine

By Danielle Ofri
Physician, Writer, Editor


Here is an excerpt:

But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices.  But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.

Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.

When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities.  Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.

The entire article is here.

Want to Change Academic Publishing? Just Say No

By Hugh Gusterson
The Chronicle of Higher Education
Originally published September 23, 2012

Here is an excerpt:

When I look at the work I do as an academic social scientist and the remuneration I receive, I see a pattern that makes little sense. This is especially the case with regard to publishing. If I review a book for a newspaper or evaluate a book for a university press, I get paid, but if I referee an article for a journal, I do not. If I publish a book, I get royalties. If I publish an opinion piece in the newspaper, I get a couple of hundred dollars. Once a magazine paid me $5,000 for an article.

But I get paid nothing directly for the most difficult, time-consuming writing I do: peer-reviewed academic articles. In fact a journal that owned the copyright to one of my articles made me pay $400 for permission to reprint my own writing in a book of my essays.

The entire article is here.

Lawrence Lessig’s March to End Corruption

Moyer's and Company
Originally posted February 14, 2014

This week, we bring you a special report on a two-week, 185-mile trek through the winter cold in New Hampshire, led in January by constitutional scholar and activist Lawrence Lessig to raise awareness of the crippling problem of corruption in American politics.

“If you think about every single important issue America has to address — if you’re on the right and you care about tax reform or addressing the issues of the deficit, or on the left and you care about climate change or real health care reform — whatever the issue is, if you look at the way our system functions right now you have to see that there will be no sensible reform given the way we fund campaigns,” Lessig says.

The entire story is here.

Research: We Should Speak Up About Ethical Violations More Often

by Joseph Grenny
Harvard Business Review
Originally published on January 8, 2014

Whistle-blowing reveals not just acute misdeeds, but chronic and longstanding patterns of misconduct. For example, Edward Snowden’s bombshell release of more than 200,000 documents revealed questionable government surveillance programs that existed for years. Miami Dolphins player Jonathan Martin withdrew from play, alleging more than a year of emotional abuse from teammate Richie Incognito. These high-profile cases are just a few examples of what happens in organizations large and small every day.

And yet, many leaders wrongly believe the path to consistent, proper conduct is special methods to reward whistle-blowing — offering incentives to truth-tellers who report major lapses. The SEC, for example, offers up to 30 percent of recovered funds as payment to those whose testimony aids in prosecution of corporate wrongdoing. One payment recently topped $14 million. Is a multimillion-dollar payday the key to corporate ethics?

The entire article is here.

Time, Money, and Morality

By Gino, F., and C. Mogilner. "Time, Money, and Morality." Psychological Science (forthcoming).

Abstract

Money, a resource that absorbs much daily attention, seems to be present in much unethical behavior thereby suggesting that money itself may corrupt. This research examines a way to offset such potentially deleterious effects—by focusing on time, a resource that tends to receive less attention than money but is equally ubiquitous in our daily lives. Across four experiments, we examine whether shifting focus onto time can salvage individuals' ethicality. We found that implicitly activating the construct of time, rather than money, leads individuals to behave more ethically by cheating less. We further found that priming time reduces cheating by making people reflect on who they are. Implications for the use of time versus money primes in discouraging or promoting dishonesty are discussed.

The entire article is here.

How Money Affects Morality

By Eduardo Porter
The New York Times - Business
Originally published June 13, 2013

From Judas Iscariot, who betrayed Jesus for 30 pieces of silver, to Bernard L. Madoff to the standard member of Congress fighting tirelessly to further the interests of campaign donors, human history is full of examples of money’s ability to weaken even the firmest ethical backbone.

Money sows mistrust. It ends friendships. Experiments have found that it encourages us to lie and cheat. As Karl Marx, the scourge of capitalism, noted, ‘‘Money then appears as the enemy of man and social bonds that pretend to self-subsistence.’’

Yet though we clearly understand money’s power to debase character, we have less certain a grasp on what it is about money that corrupts us so. Is it simply greed? Does the appetite for the more comfortable life that money can buy push us over the line?

The entire article is here.