Kelsey Hills-Evans, Julian Mitton, and Chana Sacks
AMA Journal of Ethics. January 2018, Volume 20, Number 1: 77-83.
doi: 10.1001/journalofethics.2018.20.01.pfor1-1801.
Abstract
Gun violence is a major cause of preventable injury and death in the United States, leading to more than 33,000 deaths each year. However, gun violence prevention is an understudied and underfunded area of research. We review the barriers to research in the field, including restrictions on federal funding. We then outline potential areas in which further research could inform clinical practice, public health efforts, and public policy. We also review examples of innovative collaborations among interdisciplinary teams working to develop strategies to integrate gun violence prevention into patient-doctor interactions in order to interrupt the cycle of gun violence.
An Ethical Obligation to Address Gun Violence
More than twenty survivors of the Pulse nightclub massacre traveled together to Boston, Massachusetts, in the days before the one-year anniversary of that horrific night. They met with a group of physicians, nurses, social workers, administrators, and others at our hospital to talk about their experience. They recounted their memories of the sounds of gunfire, the screams of those around them, and the moans from those felled beside them. They described the ups and downs that have characterized their attempts to rebuild in the year since gunfire shattered their sense of normalcy. They shared their stories in the hopes that if more people could understand what it means to be affected by gun violence, then we, as a nation, would be compelled to act.
The article is here.
Wednesday, March 21, 2018
Suicidal Ideation, Plans, and Attempts Among Public Safety Personnel in Canada
R. N. Carleton and others
Canadian Psychology
First published February 8, 2018
Abstract
Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research.
The research is here.
Canadian Psychology
First published February 8, 2018
Abstract
Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research.
The research is here.
Tuesday, March 20, 2018
Why Partisanship Is Such a Worthy Foe of Objective Truth
Charlotte Hu
Discover Magazine
Originally published February 20, 2018
Here is an excerpt:
Take, for example, an experiment that demonstrated party affiliation affected people’s perception of a protest video. When participants felt the video depicted liberally minded protesters, Republicans were more in favor of police intervention than Democrats. The opposite emerged when participants thought the video showed a conservative protest. The visual information was identical, but people drew vastly different conclusions that were shaded by their political group affiliation.
“People are more likely to behave in and experience emotions in ways that are congruent with the activated social identity,” says Bavel. In other words, people will go along with the group, even if the ideas oppose their own ideologies—belonging may have more value than facts.
The situation is extenuated by social media, which creates echo chambers on both the left and the right. In these concentric social networks, the same news articles are circulated, validating the beliefs of the group and strengthening their identity association with the group.
The article is here.
Discover Magazine
Originally published February 20, 2018
Here is an excerpt:
Take, for example, an experiment that demonstrated party affiliation affected people’s perception of a protest video. When participants felt the video depicted liberally minded protesters, Republicans were more in favor of police intervention than Democrats. The opposite emerged when participants thought the video showed a conservative protest. The visual information was identical, but people drew vastly different conclusions that were shaded by their political group affiliation.
“People are more likely to behave in and experience emotions in ways that are congruent with the activated social identity,” says Bavel. In other words, people will go along with the group, even if the ideas oppose their own ideologies—belonging may have more value than facts.
The situation is extenuated by social media, which creates echo chambers on both the left and the right. In these concentric social networks, the same news articles are circulated, validating the beliefs of the group and strengthening their identity association with the group.
The article is here.
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.
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.
Monday, March 19, 2018
‘The New Paradigm,’ Conscience and the Death of Catholic Morality
E. Christian Brugger
National Catholic Register
Originally published February 23, 2-18
Vatican Secretary of State Cardinal Pietro Parolin, in a recent interview with Vatican News, contends the controversial reasoning expressed in the apostolic exhortation Amoris Laetitia (The Joy of Love) represents a “paradigm shift” in the Church’s reasoning, a “new approach,” arising from a “new spirit,” which the Church needs to carry out “the process of applying the directives of Amoris Laetitia.”
His reference to a “new paradigm” is murky. But its meaning is not. Among other things, he is referring to a new account of conscience that exalts the subjectivity of the process of decision-making to a degree that relativizes the objectivity of the moral law. To understand this account, we might first look at a favored maxim of Pope Francis: “Reality is greater than ideas.”
It admits no single-dimensional interpretation, which is no doubt why it’s attractive to the “Pope of Paradoxes.” But in one area, the arena of doctrine and praxis, a clear meaning has emerged. Dogma and doctrine constitute ideas, while praxis (i.e., the concrete lived experience of people) is reality: “Ideas — conceptual elaborations — are at the service of … praxis” (Evangelii Gaudium, 232).
In relation to the controversy stirred by Amoris Laetitia, “ideas” is interpreted to mean Church doctrine on thorny moral issues such as, but not only, Communion for the divorced and civilly remarried, and “reality” is interpreted to mean the concrete circumstances and decision-making of ordinary Catholics.
The article is here.
National Catholic Register
Originally published February 23, 2-18
Vatican Secretary of State Cardinal Pietro Parolin, in a recent interview with Vatican News, contends the controversial reasoning expressed in the apostolic exhortation Amoris Laetitia (The Joy of Love) represents a “paradigm shift” in the Church’s reasoning, a “new approach,” arising from a “new spirit,” which the Church needs to carry out “the process of applying the directives of Amoris Laetitia.”His reference to a “new paradigm” is murky. But its meaning is not. Among other things, he is referring to a new account of conscience that exalts the subjectivity of the process of decision-making to a degree that relativizes the objectivity of the moral law. To understand this account, we might first look at a favored maxim of Pope Francis: “Reality is greater than ideas.”
It admits no single-dimensional interpretation, which is no doubt why it’s attractive to the “Pope of Paradoxes.” But in one area, the arena of doctrine and praxis, a clear meaning has emerged. Dogma and doctrine constitute ideas, while praxis (i.e., the concrete lived experience of people) is reality: “Ideas — conceptual elaborations — are at the service of … praxis” (Evangelii Gaudium, 232).
In relation to the controversy stirred by Amoris Laetitia, “ideas” is interpreted to mean Church doctrine on thorny moral issues such as, but not only, Communion for the divorced and civilly remarried, and “reality” is interpreted to mean the concrete circumstances and decision-making of ordinary Catholics.
The article is here.
#MeToo in Medicine: Waiting for the Reckoning
Elizabeth Chuck
NBC News
Originally posted February 21, 2018
Here is an excerpt:
Health care organizations make clear that they do not condone inappropriate behavior. The American Medical Association calls workplace sexual harassment unethical and specifically states in its Code of Medical Ethics that “Sexual relationships between medical supervisors and trainees are not acceptable, even if consensual.”
Westchester Medical Center Health Network, where Jenkins says she was sexually harassed as a resident, maintains that it has never tolerated workplace harassment. In a statement to NBC News, it said that the surgeon in question "has not worked at Westchester Medical Center for years and we have no record of a report."
"Our policies on harassment are strict, clear and presented to all employees consistently," it said.
"Mechanisms have been and continue to be in place to enable confidential reporting and allegations involving staff are investigated swiftly and thoroughly. Disciplinary actions are taken, as appropriate, after internal review," the statement said, adding that Westchester Medical Center's policies were "continuously examined and enhanced" and that reporting sexual harassment was encouraged through its confidential 24-hour hotline.
More than a hotline is needed, said many females in medicine, who want to see an overhaul of their entire profession — with men made aware of what's unacceptable and women looking out for one another and supporting each other.
The article is here.
NBC News
Originally posted February 21, 2018
Here is an excerpt:
Health care organizations make clear that they do not condone inappropriate behavior. The American Medical Association calls workplace sexual harassment unethical and specifically states in its Code of Medical Ethics that “Sexual relationships between medical supervisors and trainees are not acceptable, even if consensual.”
Westchester Medical Center Health Network, where Jenkins says she was sexually harassed as a resident, maintains that it has never tolerated workplace harassment. In a statement to NBC News, it said that the surgeon in question "has not worked at Westchester Medical Center for years and we have no record of a report."
"Our policies on harassment are strict, clear and presented to all employees consistently," it said.
"Mechanisms have been and continue to be in place to enable confidential reporting and allegations involving staff are investigated swiftly and thoroughly. Disciplinary actions are taken, as appropriate, after internal review," the statement said, adding that Westchester Medical Center's policies were "continuously examined and enhanced" and that reporting sexual harassment was encouraged through its confidential 24-hour hotline.
More than a hotline is needed, said many females in medicine, who want to see an overhaul of their entire profession — with men made aware of what's unacceptable and women looking out for one another and supporting each other.
The article is here.
Sunday, March 18, 2018
Machine Theory of Mind
Neil C. Rabinowitz, F. Perbet, H. F. Song, C. Zhang, S.M. Ali Eslami, M. Botvinick
Artificial Intelligence
Submitted February 2018
Abstract
Theory of mind (ToM; Premack & Woodruff, 1978) broadly refers to humans' ability to represent the mental states of others, including their desires, beliefs, and intentions. We propose to train a machine to build such models too. We design a Theory of Mind neural network -- a ToMnet -- which uses meta-learning to build models of the agents it encounters, from observations of their behaviour alone. Through this process, it acquires a strong prior model for agents' behaviour, as well as the ability to bootstrap to richer predictions about agents' characteristics and mental states using only a small number of behavioural observations. We apply the ToMnet to agents behaving in simple gridworld environments, showing that it learns to model random, algorithmic, and deep reinforcement learning agents from varied populations, and that it passes classic ToM tasks such as the "Sally-Anne" test (Wimmer & Perner, 1983; Baron-Cohen et al., 1985) of recognising that others can hold false beliefs about the world. We argue that this system -- which autonomously learns how to model other agents in its world -- is an important step forward for developing multi-agent AI systems, for building intermediating technology for machine-human interaction, and for advancing the progress on interpretable AI.
The research is here.
Artificial Intelligence
Submitted February 2018
Abstract
Theory of mind (ToM; Premack & Woodruff, 1978) broadly refers to humans' ability to represent the mental states of others, including their desires, beliefs, and intentions. We propose to train a machine to build such models too. We design a Theory of Mind neural network -- a ToMnet -- which uses meta-learning to build models of the agents it encounters, from observations of their behaviour alone. Through this process, it acquires a strong prior model for agents' behaviour, as well as the ability to bootstrap to richer predictions about agents' characteristics and mental states using only a small number of behavioural observations. We apply the ToMnet to agents behaving in simple gridworld environments, showing that it learns to model random, algorithmic, and deep reinforcement learning agents from varied populations, and that it passes classic ToM tasks such as the "Sally-Anne" test (Wimmer & Perner, 1983; Baron-Cohen et al., 1985) of recognising that others can hold false beliefs about the world. We argue that this system -- which autonomously learns how to model other agents in its world -- is an important step forward for developing multi-agent AI systems, for building intermediating technology for machine-human interaction, and for advancing the progress on interpretable AI.
The research is here.
Saturday, March 17, 2018
The Revised Declaration of Geneva
Ramin Walter Parsa-Parsi
JAMA. 2017;318(20):1971-1972.
Here is an excerpt:
The most notable difference between the Declaration of Geneva and other key ethical documents, such as the WMA’s Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects and the Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks, was determined to be the lack of overt recognition of patient autonomy, despite references to the physician’s obligation to exercise respect, beneficence, and medical confidentiality toward his or her patient(s). To address this difference, the workgroup, informed by other WMA members, ethical advisors, and other experts, recommended adding the following clause: “I WILL RESPECT the autonomy and dignity of my patient.” In addition, to highlight the importance of patient self-determination as one of the key cornerstones of medical ethics, the workgroup also recommended shifting all new and existing paragraphs focused on patients’ rights to the beginning of the document, followed by clauses relating to other professional obligations.
To more explicitly invoke the standards of ethical and professional conduct expected of physicians by their patients and peers, the clause “I WILL PRACTISE my profession with conscience and dignity” was augmented to include the wording “and in accordance with good medical practice.”
The article and the Declaration can be found here.
JAMA. 2017;318(20):1971-1972.
Here is an excerpt:
The most notable difference between the Declaration of Geneva and other key ethical documents, such as the WMA’s Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects and the Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks, was determined to be the lack of overt recognition of patient autonomy, despite references to the physician’s obligation to exercise respect, beneficence, and medical confidentiality toward his or her patient(s). To address this difference, the workgroup, informed by other WMA members, ethical advisors, and other experts, recommended adding the following clause: “I WILL RESPECT the autonomy and dignity of my patient.” In addition, to highlight the importance of patient self-determination as one of the key cornerstones of medical ethics, the workgroup also recommended shifting all new and existing paragraphs focused on patients’ rights to the beginning of the document, followed by clauses relating to other professional obligations.
To more explicitly invoke the standards of ethical and professional conduct expected of physicians by their patients and peers, the clause “I WILL PRACTISE my profession with conscience and dignity” was augmented to include the wording “and in accordance with good medical practice.”
The article and the Declaration can be found here.
Friday, March 16, 2018
Ethics watchdog files complaint alleging Trump lawyer's payment to Stormy Daniels violates law
Javier David
CNBC.com
Originally published March 11, 2018
A $130,000 payment made by President Donald Trump's attorney to an adult film star should be probed as a financial obligation that the president "knowingly and willfully" failed to report, a watchdog has argued.
In a legal complaint filed late last week with the Department of Justice and the Office of Government Ethics, the Citizens for Responsibility and Ethics in Washington (CREW) argued that Trump lawyer Michael Cohen's payment to Stormy Daniels "constituted a loan to President Trump that he should have reported as a liability on his public financial disclosure."
The filing raised the question of whether, as a general election candidate, Trump deliberately failed to disclose it.
CREW's argument has been raised with increasing regularity by some legal experts, who say Cohen's surreptitious payment could be viewed as an illicit campaign contribution. The attorney disclosed recently that he used a home equity loan to arrange a payment to Daniels, buying her silence for an alleged affair she had with Trump more than a decade ago.
In CREW's judgement, Trump "seemingly violated a federal law by failing to disclose it" on his campaign filings. Experts have said that had Trump paid Daniels with his own money, the payment wouldn't be an issue since candidates can contribute to their own campaigns. Yet since a disclosure wasn't made, there could be a violation.
The information is here.
CNBC.com
Originally published March 11, 2018
A $130,000 payment made by President Donald Trump's attorney to an adult film star should be probed as a financial obligation that the president "knowingly and willfully" failed to report, a watchdog has argued.In a legal complaint filed late last week with the Department of Justice and the Office of Government Ethics, the Citizens for Responsibility and Ethics in Washington (CREW) argued that Trump lawyer Michael Cohen's payment to Stormy Daniels "constituted a loan to President Trump that he should have reported as a liability on his public financial disclosure."
The filing raised the question of whether, as a general election candidate, Trump deliberately failed to disclose it.
CREW's argument has been raised with increasing regularity by some legal experts, who say Cohen's surreptitious payment could be viewed as an illicit campaign contribution. The attorney disclosed recently that he used a home equity loan to arrange a payment to Daniels, buying her silence for an alleged affair she had with Trump more than a decade ago.
In CREW's judgement, Trump "seemingly violated a federal law by failing to disclose it" on his campaign filings. Experts have said that had Trump paid Daniels with his own money, the payment wouldn't be an issue since candidates can contribute to their own campaigns. Yet since a disclosure wasn't made, there could be a violation.
The information is here.
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