Richard A. Friedman
The New York Times
Originally published February 17, 2017
Here are two excerpts:
A recent letter to the editor in this newspaper, signed by 35 psychiatrists, psychologists and social workers, put it this way: "We fear that too much is at stake to be silent." It continued, "We believe that the grave emotional instability indicated by Mr. Trump's speech and actions makes him incapable of serving safely as president."
But the attempt to diagnose a condition in President Trump and declare him mentally unfit to serve is misguided for several reasons.
First, all experts have political beliefs that probably distort their psychiatric judgment. Consider what my mostly liberal profession said of Senator Barry Goldwater, the Republican nominee for president in 1964, right before the election. Members of the American Psychiatric Association were surveyed about their assessment of Goldwater by the now-defunct Fact magazine. Many savaged him, calling him "paranoid," "grossly psychotic" and a "megalomaniac." Some provided diagnoses, like schizophrenia and narcissistic personality disorder.
They used their professional knowledge as a political weapon against a man they had never examined and who certainly would never have consented to their discussing his mental health in public.
Goldwater sued (successfully) and, as a result, in 1973 the A.P.A. developed the Goldwater Rule. It says that psychiatrists can discuss mental health issues with the news media, but that it is unethical for them to diagnose mental illnesses in people they have not examined and whose consent they have not received.
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There is one last reason we should avoid psychiatrically labeling our leaders: It lets them off the moral hook. Not all misbehavior reflects psychopathology; the fact is that ordinary human meanness and incompetence are far more common than mental illness. We should not be in the business of medicalizing bad actors.
The article is here.
Saturday, February 18, 2017
A Crime in the Cancer Lab
Theodora Ross
The New York Times
Originally published January 28, 2017
Here is an excerpt:
We have all read about incidents of scientific misconduct; in recent years, a number of manuscripts based on fake research have been retracted. But they usually involved scientists who cut corners or fabricated data, not deliberate sabotage. The poisoned flasks were a first for me. Falsified data is a crime against scientific truth. This was personal.
I turned to my colleagues to ask how to respond, and to my surprise, they all said the same thing: my student, Heather Ames, was probably sabotaging herself.
Their reasoning? She wanted an excuse for why things weren't working in her experiments. Competition and the pressure to get results quickly is ever-present in the world of biomedical research, so it's not out of the question that a young scientist might succumb to the stress.
The article is here.
The New York Times
Originally published January 28, 2017
Here is an excerpt:
We have all read about incidents of scientific misconduct; in recent years, a number of manuscripts based on fake research have been retracted. But they usually involved scientists who cut corners or fabricated data, not deliberate sabotage. The poisoned flasks were a first for me. Falsified data is a crime against scientific truth. This was personal.
I turned to my colleagues to ask how to respond, and to my surprise, they all said the same thing: my student, Heather Ames, was probably sabotaging herself.
Their reasoning? She wanted an excuse for why things weren't working in her experiments. Competition and the pressure to get results quickly is ever-present in the world of biomedical research, so it's not out of the question that a young scientist might succumb to the stress.
The article is here.
Friday, February 17, 2017
There is something rotten inside the medical profession
Anonymous
kevinmd.com
Originally published January 26, 2017
In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.
Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients — which is often sadly a given, but for the doctors training inside it. Every generation always looks down on the generation training after it — no one ever had it as hard as them, and thus deserve to suffer just as much, if not more. This dubious school of thought has long been acknowledged as standard practice. To be a good doctor, you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing, and if you admit to struggling, the unspoken opinion (or often spoken) is that you simply couldn’t hack it.
In the cutthroat, often brutalizing culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent — death by their own hand.
The blog post is here.
kevinmd.com
Originally published January 26, 2017
In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.
Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients — which is often sadly a given, but for the doctors training inside it. Every generation always looks down on the generation training after it — no one ever had it as hard as them, and thus deserve to suffer just as much, if not more. This dubious school of thought has long been acknowledged as standard practice. To be a good doctor, you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing, and if you admit to struggling, the unspoken opinion (or often spoken) is that you simply couldn’t hack it.
In the cutthroat, often brutalizing culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent — death by their own hand.
The blog post is here.
Uncertainty Increases the Reliance on Affect in Decisions
Ali Faraji Rad and Michel Tuan Pham
J Consum Res (2017) ucw073.
Published: 23 January 2017
Abstract
How do psychological states of uncertainty influence the way people make decisions? We propose that such states increase the reliance on affective inputs in judgments and decisions. In accord with this proposition, results from six studies show that the priming of uncertainty (vs. certainty) consistently increases the effects of a variety of affective inputs on consumers’ judgments and decisions. Primed uncertainty is shown to amplify the effects of the pleasantness of a musical soundtrack (study 1), the attractiveness of a picture (study 2), the appeal of affective attributes (studies 3 and 4), incidental mood states (study 6), and even incidental states of disgust (study 5). Moreover, both negative and positive uncertainty increase the influence of affect in decisions (study 4). The results additionally show that the increased reliance on affective inputs under uncertainty does not necessarily come at the expense of a reliance on descriptive attribute information (studies 2 and 5), and that the increased reliance on affect under uncertainty is distinct from a general reliance on heuristic or peripheral cues (study 6). The phenomenon may be due to uncertainty threatening the self, thereby encouraging a reliance on inputs that are closer to the self and have high subjective validity.
The article is here.
J Consum Res (2017) ucw073.
Published: 23 January 2017
Abstract
How do psychological states of uncertainty influence the way people make decisions? We propose that such states increase the reliance on affective inputs in judgments and decisions. In accord with this proposition, results from six studies show that the priming of uncertainty (vs. certainty) consistently increases the effects of a variety of affective inputs on consumers’ judgments and decisions. Primed uncertainty is shown to amplify the effects of the pleasantness of a musical soundtrack (study 1), the attractiveness of a picture (study 2), the appeal of affective attributes (studies 3 and 4), incidental mood states (study 6), and even incidental states of disgust (study 5). Moreover, both negative and positive uncertainty increase the influence of affect in decisions (study 4). The results additionally show that the increased reliance on affective inputs under uncertainty does not necessarily come at the expense of a reliance on descriptive attribute information (studies 2 and 5), and that the increased reliance on affect under uncertainty is distinct from a general reliance on heuristic or peripheral cues (study 6). The phenomenon may be due to uncertainty threatening the self, thereby encouraging a reliance on inputs that are closer to the self and have high subjective validity.
The article is here.
Thursday, February 16, 2017
First human-pig 'chimera' created in milestone study
Hannah Devlin
The Guardian
Originally posted January 26, 2017
Scientists have created a human-pig hybrid in a milestone study that raises the prospect of being able to grow human organs inside animals for use in transplants.
It marks the first time that embryos combining two large, distantly-related species have been produced. The creation of this so-called chimera – named after the cross-species beast of Greek mythology – has been hailed as a significant first step towards generating human hearts, livers and kidneys from scratch.
Juan Carlos Izpisua Belmonte, who led the work on the part-pig, part-human embryos at the Salk Institute for Biological Studies in La Jolla, California, said: “The ultimate goal is to grow functional and transplantable tissue or organs, but we are far away from that. This is an important first step.”
The study has reignited ethical concerns that have threatened to overshadow the field’s clinical promise. The work inevitably raises the spectre of intelligent animals with humanised brains and also the potential for bizarre hybrid creatures to be accidentally released into the wild. The US National Institutes of Health (NIH) placed a moratorium on funding for the controversial experiments last year while these risks were considered.
The article is here.
The Guardian
Originally posted January 26, 2017
Scientists have created a human-pig hybrid in a milestone study that raises the prospect of being able to grow human organs inside animals for use in transplants.
It marks the first time that embryos combining two large, distantly-related species have been produced. The creation of this so-called chimera – named after the cross-species beast of Greek mythology – has been hailed as a significant first step towards generating human hearts, livers and kidneys from scratch.
Juan Carlos Izpisua Belmonte, who led the work on the part-pig, part-human embryos at the Salk Institute for Biological Studies in La Jolla, California, said: “The ultimate goal is to grow functional and transplantable tissue or organs, but we are far away from that. This is an important first step.”
The study has reignited ethical concerns that have threatened to overshadow the field’s clinical promise. The work inevitably raises the spectre of intelligent animals with humanised brains and also the potential for bizarre hybrid creatures to be accidentally released into the wild. The US National Institutes of Health (NIH) placed a moratorium on funding for the controversial experiments last year while these risks were considered.
The article is here.
Whatever happened to the DeepMind AI ethics board Google promised?
Alex Hurn
The Guardian
Originally posted January 26, 2017
Three years ago, artificial intelligence research firm DeepMind was acquired by Google for a reported £400m. As part of the acquisition, Google agreed to set up an ethics and safety board to ensure that its AI technology is not abused.
The existence of the ethics board wasn’t confirmed at the time of the acquisition announcement, and the public only became aware of it through a leak to industry news site The Information. But in the years since, senior members of DeepMind have publicly confirmed the board’s existence, arguing that it is one of the ways that the company is trying to “lead the way” on ethical issues in AI.
But in all that time DeepMind has consistently refused to say who is on the board, what it discusses, or publicly confirm whether or not it has even officially met. The Guardian has asked DeepMind and Google multiple times since the acquisition on 26 January 2014 for transparency around the board, and received just one answer on the record.
The article is here.
The Guardian
Originally posted January 26, 2017
Three years ago, artificial intelligence research firm DeepMind was acquired by Google for a reported £400m. As part of the acquisition, Google agreed to set up an ethics and safety board to ensure that its AI technology is not abused.
The existence of the ethics board wasn’t confirmed at the time of the acquisition announcement, and the public only became aware of it through a leak to industry news site The Information. But in the years since, senior members of DeepMind have publicly confirmed the board’s existence, arguing that it is one of the ways that the company is trying to “lead the way” on ethical issues in AI.
But in all that time DeepMind has consistently refused to say who is on the board, what it discusses, or publicly confirm whether or not it has even officially met. The Guardian has asked DeepMind and Google multiple times since the acquisition on 26 January 2014 for transparency around the board, and received just one answer on the record.
The article is here.
Wednesday, February 15, 2017
Recent Trump win on China trademark raises ethics questions
Erika Kinetz
Associated Press
Originally published February 14, 2017
Here is an excerpt:
Ethics lawyers say the trademarks present conflicts of interest for Trump and may violate the emoluments clause of the U.S. Constitution, which bars public servants from accepting anything of value from foreign governments unless explicitly approved by Congress.
Countries could use Trump's desire to control his brand to extend — or withhold — favor, especially a nation such as China where the courts and bureaucracy reflect the imperatives of the ruling Communist Party.
"There can be no question that it is a terrible idea for Donald Trump to be accepting the registration of these valuable property rights from China while he's a sitting president of the United States," said Norman Eisen, who served as chief White House ethics lawyer for President Barack Obama. "It's fair to conclude that this is an effort to influence Mr. Trump that is relatively inexpensive for the Chinese, potentially very valuable to him, but it could be very costly for the United States."
The article is here.
Associated Press
Originally published February 14, 2017
Here is an excerpt:
Ethics lawyers say the trademarks present conflicts of interest for Trump and may violate the emoluments clause of the U.S. Constitution, which bars public servants from accepting anything of value from foreign governments unless explicitly approved by Congress.
Countries could use Trump's desire to control his brand to extend — or withhold — favor, especially a nation such as China where the courts and bureaucracy reflect the imperatives of the ruling Communist Party.
"There can be no question that it is a terrible idea for Donald Trump to be accepting the registration of these valuable property rights from China while he's a sitting president of the United States," said Norman Eisen, who served as chief White House ethics lawyer for President Barack Obama. "It's fair to conclude that this is an effort to influence Mr. Trump that is relatively inexpensive for the Chinese, potentially very valuable to him, but it could be very costly for the United States."
The article is here.
Judge Allows Lawsuit Against Psychologists in C.I.A. Torture Case
Sheri Fink
The New York Times
Originally published January 29, 2017
A federal judge on Friday allowed a case brought by former detainees to move forward against two American psychologists who helped devise the C.I.A.’s now-defunct program to interrogate terrorism suspects using techniques widely considered to be torture.
A United States District Court judge, Justin L. Quackenbush, denied a motion by the psychologists that sought to dismiss the case for lack of jurisdiction under provisions of a 2006 law that limits the ability of detainees to challenge their treatment.
“This ruling sends the strong signal that anyone who participates in shameful and unlawful government torture can’t count on escaping accountability in a court of law,” said Dror Ladin, a staff attorney for the American Civil Liberties Union, which, with the Gibbons law firm in Newark, represents the former detainees.
The article is here.
The New York Times
Originally published January 29, 2017
A federal judge on Friday allowed a case brought by former detainees to move forward against two American psychologists who helped devise the C.I.A.’s now-defunct program to interrogate terrorism suspects using techniques widely considered to be torture.
A United States District Court judge, Justin L. Quackenbush, denied a motion by the psychologists that sought to dismiss the case for lack of jurisdiction under provisions of a 2006 law that limits the ability of detainees to challenge their treatment.
“This ruling sends the strong signal that anyone who participates in shameful and unlawful government torture can’t count on escaping accountability in a court of law,” said Dror Ladin, a staff attorney for the American Civil Liberties Union, which, with the Gibbons law firm in Newark, represents the former detainees.
The article is here.
Tuesday, February 14, 2017
Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes
Hannawa, A. F., Shigemoto, Y., & Little, T. (2016).
Social Science & Medicine, 156, 29-38.
Abstract
Rationale
This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error.
Objective
This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes.
Methods
In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes.
Results
The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice.
Conclusion
The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.
The article is here.
Social Science & Medicine, 156, 29-38.
Abstract
Rationale
This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error.
Objective
This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes.
Methods
In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes.
Results
The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice.
Conclusion
The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.
The article is here.
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