Medical Evidence Debated

Ralph Bartholdt
Coeur d’Alene Press 
Originally posted October 27, 2017

Here is an excerpt:

“The point of this is not that he had a choice,” he said. “But what’s been loaded into his system, what’s he’s making the choices with.”

Thursday’s expert witness, psychologist Richard Adler, further developed the argument that Renfro suffered from a brain disorder evidenced by a series of photograph-like images of Renfro’s brain that showed points of trauma. He pointed out degeneration of white matter responsible for transmitting information from the front to the back of the brain, and shrunken portions on one side of the brain that were not symmetrical with their mirror images on the other side.

Physical evidence coinciding with the findings include Renfro’s choppy speech patterns and mannerisms as well inabilities to make cognitive connections, and his lack of social skills, Adler said.

Defense attorney Jay Logsdon asked if the images were obtained through a discredited method, one that has “been attacked as junk science?”

The method, called QEEG, for quantitative electroencephalogram, which uses electrical patterns that show electrical activity inside the brain’s cortex to determine impairment, was attacked in an article in 1997. The article’s criticism still stands today, Adler said.

Throughout the morning and into the afternoon, Adler reiterated findings, linking them to the defendant’s actions, and dovetailing them into other test results, psychological and cognitive, that have been conducted while Renfro has been incarcerated in the Kootenai County Jail.

The article is here.

Why You Don’t See the Forest for the Trees When You Are Anxious: Anxiety Impairs Intuitive Decision Making

Carina Remmers and Thea Zander
Clinical Psychological Science
First Published September 27, 2017

Abstract

Intuitive decisions arise effortlessly from an unconscious, associative coherence detection process. Hereby, they guide people adaptively through everyday life decision making. When people are anxious, however, they often make poor decisions or no decision at all. Is intuition impaired in a state of anxiety? The aim of the current experiment was to examine this question in a between-subjects design. A total of 111 healthy participants were randomly assigned to an anxious, positive, or neutral multimodal mood induction after which they performed the established semantic coherence task. This task operationalizes intuition as the sudden, inexplicable detection of environmental coherence, based on automatic, unconscious processes of spreading activation. The current findings show that anxious participants showed impaired intuitive performance compared to participants of the positive and neutral mood groups. Trait anxiety did not moderate this effect. Accordingly, holistic, associative processes seem to be impaired by anxiety. Clinical implications and directions for future research are discussed.

The article is here.

Did I just feed an addiction? Or ease a man’s pain? Welcome to modern medicine’s moral cage fight

Jay Baruch
STAT News
Originally published October 23, 2017

Here are two excerpts:

Will the opioid pills Sonny is asking for treat his pain, feed an addiction, or both? Will prescribing it fulfill my moral responsibility to alleviate his distress, contribute to the supply chain in the illicit pill economy, or both? Prescribing guidelines from the Centers for Disease Control and Prevention and recommendations from medical specialties and local hospitals are well-intentioned and necessary. But they do little to address the central anxiety that makes this decision a source of distress for physicians like me. It’s hard to evaluate pain without making some judgment about the patient and the patient’s story.

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A good story shortcuts analytical thinking. It can work its charms without our knowledge and sometimes against our better judgment. Once an emotional connection is made and the listener becomes invested in the story, the believability of the story matters less. In fact, the more extreme the story, the greater its capacity to enthrall the listener or reader.

Stories can elicit empathy and influence behavior in part by stimulating the release of the neurotransmitter oxytocin, which has ties to generosity, trustworthiness, and mother-infant bonding. I’m intrigued by the possibility that clinicians’ vulnerability to deceit is often grounded in the empathy they are reported to be lacking.

The article is here.

Court ruling on expert testimony could open door to junk science

Andis Robeznieks
AMA Wire
Originally posted October 20, 2017

The New Jersey Supreme Court is expected to issue a ruling soon that may affect more than 2,000 cases before the state’s courts. The court’s decision could have an even more far-reaching impact and might eventually undermine medical research, patient-physician decision making and informed consent.

The issue is whether scientific testimony expressing refuted theories that have not been subjected to peer review and do not follow the traditional hierarchy of scientific evidence should be admissible in litigation involving plaintiffs who claim their inflammatory bowel disease (IBD) was caused by the drug isotretinoin, marketed as Accutane by Hoffmann-La Roche, formerly headquartered in Nutley, N.J.

The first lawsuit on this matter was filed in July 2003. A hearing on whether the plaintiffs’ witnesses would be allowed to testify was held in February 2015, after which trial Judge Nelson C. Johnson barred their testimony. In May 2015, Johnson dismissed 2,076 related cases based on his ruling about the evidence.

This past July, a three-judge panel of the state appellate court reversed both the ruling barring the testimony and the dismissal of the cases. Hoffman-La Roche has requested the state Supreme Court to review this ruling.

The pressor is here.

Genetic testing of embryos creates an ethical morass

 Andrew Joseph
STAT news
Originally published October 23, 2017

Here is an excerpt:

The issue also pokes at a broader puzzle ethicists and experts are trying to reckon with as genetic testing moves out of the lab and further into the hands of consumers. People have access to more information about their own genes — or, in this case, about the genes of their potential offspring — than ever before. But having that information doesn’t necessarily mean it can be used to inform real-life decisions.

A test can tell prospective parents that their embryo has an abnormal number of chromosomes in its cells, for example, but it cannot tell them what kind of developmental delays their child might have, or whether transferring that embryo into a womb will lead to a pregnancy at all. Families and physicians are gazing into five-day-old cells like crystal balls, seeking enlightenment about what might happen over a lifetime. Plus, the tests can be wrong.

“This is a problem that the rapidly developing field of genetics is facing every day and it’s no different with embryos than it is when someone is searching Ancestry.com,” said Judith Daar, a bioethicist and clinical professor at University of California, Irvine, School of Medicine. “We’ve learned a lot, and the technology is marvelous and can be predictive and accurate, but we’re probably at a very nascent stage of understanding the impact of what the genetic findings are on health.”

Preimplantation genetic testing, or PGT, emerged in the 1990s as a way to study the DNA of embryos before they’re transferred to a womb, and the technology has grown more advanced with time. Federal data show it has been used in about 5 percent of IVF procedures going back several years, but many experts pin the figure as high as 20 or 30 percent.

The article is here.

Morality and Machines

Robert Fry
Prospect
Originally published October 23, 2017

Here is an excerpt:

It is axiomatic that robots are more mechanically efficient than humans; equally they are not burdened with a sense of self-preservation, nor is their judgment clouded by fear or hysteria. But it is that very human fallibility that requires the intervention of the defining human characteristic—a moral sense that separates right from wrong—and explains why the ethical implications of the autonomous battlefield are so much more contentious than the physical consequences. Indeed, an open letter in 2015 seeking to separate AI from military application included the signatures of such luminaries as Elon Musk, Steve Wozniak, Stephen Hawking and Noam Chomsky. For the first time, therefore, human agency may be necessary on the battlefield not to take the vital tactical decisions but to weigh the vital moral ones.

So, who will accept these new responsibilities and how will they be prepared for the task? The first point to make is that none of this is an immediate prospect and it may be that AI becomes such a ubiquitous and beneficial feature of other fields of human endeavour that we will no longer fear its application in warfare. It may also be that morality will co-evolve with technology. Either way, the traditional military skills of physical stamina and resilience will be of little use when machines will have an infinite capacity for physical endurance. Nor will the quintessential commander’s skill of judging tactical advantage have much value when cognitive computing will instantaneously integrate sensor information. The key human input will be to make the judgments that link moral responsibility to legal consequence.

The article is here.

You Don’t Find Your Purpose — You Build It

John Coleman
Harvard Business Review
Originally published October 20, 2017

Here are two excerpts:

In achieving professional purpose, most of us have to focus as much on making our work meaningful as in taking meaning from it. Put differently, purpose is a thing you build, not a thing you find. Almost any work can possess remarkable purpose. School bus drivers bear enormous responsibility — caring for and keeping safe dozens of children — and are an essential part of assuring our children receive the education they need and deserve. Nurses play an essential role not simply in treating people’s medical conditions but also in guiding them through some of life’s most difficult times. Cashiers can be a friendly, uplifting interaction in someone’s day — often desperately needed — or a forgettable or regrettable one. But in each of these instances, purpose is often primarily derived from focusing on what’s so meaningful and purposeful about the job and on doing it in such a way that that meaning is enhanced and takes center stage. Sure, some jobs more naturally lend themselves to senses of meaning, but many require at least some deliberate effort to invest them with the purpose we seek.

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Most of us will have multiple sources of purpose in our lives. For me, I find purpose in my children, my marriage, my faith, my writing, my work, and my community. For almost everyone, there’s no one thing we can find. It’s not purpose but purposes we are looking for — the multiple sources of meaning that help us find value in our work and lives. Professional commitments are only one component of this meaning, and often our work isn’t central to our purpose but a means to helping others, including our families and communities. Acknowledging these multiple sources of purpose takes the pressure off of finding a single thing to give our lives meaning.

The article is here.

The Social Origins of Disgust

Joshua Rottman, Jasmine M. DeJesus, and Emily Gerdin
Forthcoming in The Moral Psychology of Disgust (Nina Strohminger and Victor Kumar, Eds.)

Despite being perfectly nutritious, consuming bugs is considered gross in many cultures
(Ruby, Rozin, and Chan 2015). This disgust reaction carries severe consequences. Considering
the negative environmental impacts of the growing consumption of beef, poultry, and fish, the
United Nations Food and Agriculture Organization has identified eating insects as a sustainable
solution for maintaining protein-rich diets (van Huis et al. 2013), but the prevalent disgust
reaction to this initiative presents a substantial hurdle. What is the function of such an irrational
response, one that may continue to endanger the natural environment? Do people experience
disgust toward insects because of perceived disease risks? Are people reacting to the reminder
that they are eating an animal, in the same way that many people react negatively to eating a
whole fish (with its head and eyes) compared to a fish fillet? We argue that social risks may
instead be motivating this reaction. More broadly, moving beyond the example of entomophagy,
we claim that disgust is much more deeply enmeshed in social and moral considerations than has
been previously acknowledged.

The scientific study of disgust has been predominantly concerned with uncovering its
ultimate adaptive purpose. Theories about the function of disgust abound, ranging from the
abhorrence of disorder and ambiguity (Douglas 1966) to an existential recoiling from reminders
of mortality and animality (Becker 1973; Goldenberg et al. 2001; Nussbaum 2004). However, a
clear front-runner has emerged amongst these diverse proposals: Disgust evolved because it has
helped humans to avoid physical contact with poisons, parasites, and pathogens. In this chapter,
we propose an alternative to the recurrent claim that disgust evolved for the sole purpose of
facilitating the avoidance of toxins and infectious disease (e.g., Chapman and Anderson 2012;
Curtis 2011; Curtis and Biran 2001; Davey 2011; Rozin and Fallon 1987; Rozin, Haidt, and
Fincher 2009; Schaller and Park 2011; Stevenson, Case, and Oaten 2009; Tybur et al. 2013).
Because this paradigmatic idea posits a purely physical (i.e., non-social) reason for the existence
of disgust, we refer to it as the “Physical Origins” hypothesis.

The book chapter is here.

Are religious people more moral?

Dimitris Xygalatas
The San Francisco Chronicle
Originally published October 23, 2017

Here is an excerpt:

For one thing, the ethical ideals of one religion might seem immoral to members of another. For instance, in the 19th century, Mormons considered polygamy a moral imperative, while Catholics saw it as a mortal sin.

Moreover, religious ideals of moral behavior are often limited to group members and might even be accompanied by outright hatred against other groups. In 1543, for example, Martin Luther, one of the fathers of Protestantism, published a treatise titled “On the Jews and their Lies,” echoing anti-Semitic sentiments that have been common among various religious groups for centuries.

These examples also reveal that religious morality can and does change with the ebb and flow of the surrounding culture. In recent years, several Anglican churches have revised their moral views to allow contraception, the ordination of women and the blessing of same-sex unions.

In any case, religiosity is only loosely related to theology. That is, the beliefs and behaviors of religious people are not always in accordance with official religious doctrines. Instead, popular religiosity tends to be much more practical and intuitive. This is what religious studies scholars call “theological incorrectness.”

Buddhism, for example, may officially be a religion without gods, but most Buddhists still treat Buddha as a deity. Similarly, the Catholic Church vehemently opposes birth control, but the vast majority of Catholics practice it anyway. In fact, theological incorrectness is the norm rather than the exception among believers.

For this reason, sociologist Mark Chaves called the idea that people behave in accordance with religious beliefs and commandments the “religious congruence fallacy.”

The article is here.