Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Wednesday, February 20, 2019

Precision medicine’s rosy predictions haven’t come true. We need fewer promises and more debate

Michael Joyner and Nigel Paneth
STATnews.com
Originally published February 7, 2019

Here is an excerpt:

While we are occasionally told that we are Luddites or nihilists (generally without much debate of the merits of our position), the most frequent communications we receive have been along the lines of “I agree with you, but can’t speak up publicly for fear of losing my grants, alienating powerful people, or upsetting my dean.” This atmosphere cannot be good for the culture of science.

We are calling for an open debate, in all centers of biomedical research, about the best way forward, and about whether precision medicine is really the most promising avenue for progress. It is time for precision medicine supporters to engage in debate — to go beyond asserting the truism that all individuals are unique, and that the increase in the volume of health data and measurements combined with the decline in the cost of studying the genome constitute sufficient argument for the adoption of the precision medicine program.

Enthusiasts of precision medicine must stop evading the tough questions we raise. The two of us have learned enormously from the free and open exchange of ideas among our small band of dissenters, and we look forward to a vigorous debate engaging an ever-larger fraction of the scientific community.

The info is here.

Why Won’t John Roberts Accept an Ethics Code for Supreme Court Justices?

Steven Lubet
Slate.com
Originally posted January 16, 2019

Here is an excerpt:

Chief Justice John Roberts addressed the anomaly of the missing ethics code in his 2011 Year-End Report on the Federal Judiciary, acknowledging that the lower courts’ code is a good “starting point” for ethics inquiries. Nonetheless, he asserted that there is “no reason” to adopt a SCOTUS code because members of his court consult a wide variety of other sources for guidance. In addition, Roberts noted that current iterations of the judicial code do “not adequately answer some of the ethical considerations unique to the Supreme Court,” and that “no compilation of ethical rules can guarantee integrity.”

The chief justice’s observations are all reasonable, but they do not begin to justify the absence of a Supreme Court code. Nearly all of his explanations apply with equal force to every other court in the U.S., and yet those courts have, without exception, adopted written codes. It is true, of course, that no “compilation” of rules can guarantee compliance, but the same could be said for all other codes, ranging from the Bill of Rights to the Ten Commandments. He is right that existing judicial codes do not address issues “unique to the Supreme Court,” but that is why the proposed legislation allows “provisions that are applicable only” to SCOTUS justices.

The info is here.

Tuesday, February 19, 2019

Even psychological placebos have an effect

University of Basel Press Release
Published February 5, 2019

Psychotherapy and placebos are both psychological interventions that not only have comparable effects, but that are also based on very similar mechanisms. Both forms of treatment are heavily influenced by the relationship between patients and those treating them, as well as by the expectations of recovery. Whereas placebo research mostly focuses on a biomedical model – an inert pill is provided with a medical rationale, which produces a corresponding effect – little is known about the effect of placebos provided with a psychological rationale.

“Green is calming”

Placebos can also have effects when specific psychological effects are attributed to them. This is the conclusion that researchers from the Division of Clinical Psychology and Psychotherapy at the University of Basel reached in three independent experiments with 421 healthy participants. The accompanying explanation – the narrative – played a key role when dispensing the placebos, as did the relationship between the researchers and the participants.

The researchers used the color green as the placebo in the video experiments, examining it both with and without a psychological narrative (“green is calming because it activates early conditioned emotional schemata”), as well as in the context of a neutral or a friendly relationship.

After viewing the videos, the participants assessed their subjective condition with questionnaires over several days. The results showed that the placebo had a positive effect on the participants’ well-being when it was prescribed together with a psychological narrative and in the context of a friendly relationship. The observed effect was strongest after administering the placebo but remained evident for up to one week.

Ethical implications

“The observed effects were comparable with those of psychotherapeutic interventions in the same populations,” says principal investigator Professor Jens Gaab. The fact that psychological placebos can have significant effects is not only important for understanding psychological interventions: “It challenges both research and clinical practice to address these mechanisms and effects, as well as their ethical implications.”

The pressor is here

How Our Attitude Influences Our Sense Of Morality

Konrad Bocian
Science Trend
Originally posted January 18, 2019

Here is an excerpt:

People think that their moral judgment is as rational and objective as scientific statements, but science does not confirm that belief. Within the two last decades, scholars interested in moral psychology discovered that people produce moral judgments based on fast and automatic intuitions than rational and controlled reasoning. For example, moral cognition research showed that moral judgments arise in approximately 250 milliseconds, and even then we are not able to explain them. Developmental psychologists proved that at already the age of 3 months, babies who do not have any lingual skills can distinguish a good protagonist (a helping one) from a bad one (a hindering one). But this does not mean that peoples’ moral judgments are based solely on intuitions. We can use deliberative processes when conditions are favorable – when we are both motivated to engage in and capable of conscious responding.

When we imagine how we would morally judge other people in a specific situation, we refer to actual rules and norms. If the laws are violated, the act itself is immoral. But we forget that intuitive reasoning also plays a role in forming a moral judgment. It is easy to condemn the librarian when our interest is involved on paper, but the whole picture changes when real money is on the table. We have known that rule for a very long time, but we still forget to use it when we predict our moral judgments.

Based on previous research on the intuitive nature of moral judgment, we decided to test how far our attitudes can impact our perception of morality. In our daily life, we meet a lot of people who are to some degree familiar, and we either have a positive or negative attitude toward these people.

The info is here.

Monday, February 18, 2019

Trump lawyers may have given false info about Cohen payments

Tal Axelrod
thehill.com
Originally posted February 15, 2019

Rep. Elijah Cummings (D-Md.), the chairman of the House Oversight and Reform Committee, said Friday the panel believes two attorneys for President Trump may have given false information to government ethics officials.

Cummings said the panel has reviewed newly uncovered documents from the Office of Government Ethics (OGE) suggesting Trump's personal lawyer Sheri Dillon and former White House lawyer Stefan Passantino gave false info about hush-money payments to adult-film actress Stormy Daniels and former Playboy model Karen McDougal.

“It now appears that President Trump’s other attorneys — at the White House and in private practice — may have provided false information about these payments to federal officials,” Cummings wrote in a letter to White House Counsel Pat Cipollone.

Cummings said Dillon “repeatedly stated to federal officials at OGE that President Trump never owed any money to Mr. Cohen in 2016 and 2017” and Passantino falsely told officials that Trump and his former lawyer Michael Cohen had a “retainer agreement.”

The info is here.

State ethics director resigns after porn, misconduct allegations

Richard Belcher
WSB-TV2
Originally published February 8, 2019

The director of the state Ethics Commission has resigned -- with a $45,000 severance -- and it’s still unknown whether accusations against him have been substantiated.

In January, Channel 2 Action News and The Atlanta Journal-Constitution broke the story that staff members at the Ethics Commission wrote letters accusing Stefan Ritter of poor work habits and of watching pornography in the office.

Ritter was placed on leave with pay to allow time to investigate the complaints.

Ritter continued to draw his $181,000 salary while the accusations against him were investigated, but he and the commission cut a deal before the investigation was over.

The info is here.

Sunday, February 17, 2019

Physician burnout now essentially a public health crisis

Priyanka Dayal McCluskey
Boston Globe
Originally posted January 17, 2019

Physician burnout has reached alarming levels and now amounts to a public health crisis that threatens to undermine the doctor-patient relationship and the delivery of health care nationwide, according to a report from Massachusetts doctors to be released Thursday.

The report — from the Massachusetts Medical Society, the Massachusetts Health & Hospital Association, and the Harvard T.H. Chan School of Public Health — portrays a profession struggling with the unyielding demands of electronic health record systems and ever-growing regulatory burdens.

It urges hospitals and medical practices to take immediate action by putting senior executives in charge of physician well-being and by giving doctors better access to mental health services. The report also calls for significant changes to make health record systems more user-friendly.

While burnout has long been a worry in the profession, the report reflects a newer phenomenon — the draining documentation and data entry now required of doctors. Today’s electronic record systems are so complex that a simple task, such as ordering a prescription, can take many clicks.

The info is here.

Saturday, February 16, 2019

There’s No Such Thing as Free Will

Stephen Cave
The Atlantic
Originally published June 2016

Here is an excerpt:

What is new, though, is the spread of free-will skepticism beyond the laboratories and into the mainstream. The number of court cases, for example, that use evidence from neuroscience has more than doubled in the past decade—mostly in the context of defendants arguing that their brain made them do it. And many people are absorbing this message in other contexts, too, at least judging by the number of books and articles purporting to explain “your brain on” everything from music to magic. Determinism, to one degree or another, is gaining popular currency. The skeptics are in ascendance.

This development raises uncomfortable—and increasingly nontheoretical—questions: If moral responsibility depends on faith in our own agency, then as belief in determinism spreads, will we become morally irresponsible? And if we increasingly see belief in free will as a delusion, what will happen to all those institutions that are based on it?

(cut)

Determinism not only undermines blame, Smilansky argues; it also undermines praise. Imagine I do risk my life by jumping into enemy territory to perform a daring mission. Afterward, people will say that I had no choice, that my feats were merely, in Smilansky’s phrase, “an unfolding of the given,” and therefore hardly praiseworthy. And just as undermining blame would remove an obstacle to acting wickedly, so undermining praise would remove an incentive to do good. Our heroes would seem less inspiring, he argues, our achievements less noteworthy, and soon we would sink into decadence and despondency.

The info is here.

Friday, February 15, 2019

The Economic Effects of Facebook

Mosquera, Roberto,  Odunowo, Mofioluwasademi, and others
December 1, 2018.
http://dx.doi.org/10.2139/ssrn.3312462

Abstract

Social media permeates many aspects of our lives, including how we connect with others, where we get our news and how we spend our time. Yet, we know little about the economic effects for users. Using a large field experiment with over 1,765 individuals, we document the value of Facebook to users and its causal effect on news consumption and awareness, well-being and daily activities. Participants reveal how much they value one week of Facebook usage and are then randomly assigned to a validated Facebook restriction or normal use. Those who are off Facebook for a week reduce news consumption, are less likely to recognize politically-skewed news stories, report being less depressed and engage in healthier activities. One week of Facebook is worth $25, and this increases by 15% after experiencing a Facebook restriction (26% for women), reflecting information loss or that using Facebook may be addictive.

Ethical/Clinical Question: Knowing this research, is it ethical and clinically appropriate to recommend depressed patients to stop using Facebook?