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

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

Sunday, March 31, 2013

Leading pediatricians' group backs same-sex marriage

Originally posted on March 21, 2013

The nation's most influential pediatrician's group has endorsed same-sex marriage, saying a stable relationship between parents regardless of sexual orientation contributes to a child's health and well-being.

The new policy of the American Academy of Pediatrics, published online Thursday, cites research showing that the parents' sexual orientation has no effect on a child's development. Kids fare just as well in same-sex or straight families when they are nurturing and financially and emotionally stable, the academy says.

Separately, a new national survey shows the nation's views on same-sex marriage are more favorable -- in large part because of a shift in attitudes among those who know someone who is gay or became more accepting as they got older of gays and lesbians.

The Pew Research Center poll also finds that a large group of younger adults who tend to be more open to gay rights is driving the numbers upward.

The entire article is here.

Saturday, March 30, 2013

Patients should decide what the end of life is like, study says

By Mary VacVean
The Los Angeles Times
Originally published March 20, 2013

Finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars, UCLA researchers said Tuesday.

“You can improve care while reducing costs by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,” Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, said in a statement.

Bergman and colleagues wrote an article advocating for patient-centered care at the end of life in the journal JAMA Surgery.

People who are dying often receive care that is poorly coordinated and not in line with the patient’s values or goals, the journal authors said. That should change, they said.

The entire article is here.

Do We Need 'Thanaticians' for the Terminally Ill?

By Ronald W. Pies
Medscape - Ethics in Psychiatry
Originally published September 26, 2012

My 89-year-old mother had been losing ground for some years, experiencing what geriatricians sometimes call "the dwindles." Toward the end of her life, she was beset by a deteriorating heart; an inability to walk; and occasional, severe gastrointestinal pain. My family got her the best medical treatment available -- eventually including home hospice care -- and she generally maintained a positive attitude throughout her long downhill slide.

But one day, as I sat beside her bed, she seemed unusually subdued. "Honey," she said, "How do I get out of this mess?" I had a pretty good idea of what she was really asking me, but I deflected her question with another question: "Ma, what 'mess' do you mean?" I asked. "It's all right," she replied, smiling sadly, "I'll manage."

My mother was doing what she had always done: sparing her children from pain. In this case, it was the pain of dealing with the waning days of her life and the frustration of knowing there was no easy escape from the burdens of dying slowly. "Ma, I'll always make sure you are getting enough treatment for your pain," I added, taking her hand -- knowing that the prospect of unremitting pain is often an underlying fear of terminally ill persons.

Yet, unspoken in my mother's question was the issue of so-called physician-assisted dying, sometimes called "physician-assisted suicide" -- an enormously heated controversy both outside and within the medical profession. In my home state, Massachusetts, the issue has come to the fore, owing to a November ballot initiative for a measure that would allow terminally ill patients to be prescribed lethal drugs. A closely related bill (H.3884) has also come before the Massachusetts Legislature's Joint Committee on the Judiciary.

The entire ethical dilemma is here.

Friday, March 29, 2013

Kaiser Permanente cited for EHR mental health violations

By Jennifer Bresnick
EHR Intelligence
Originally published on March 20, 2013

Kaiser Permanente, the largest healthcare provider in California, has been cited by the California Department of Managed Healthcare (DMHC) for keeping two sets of patient records: an official EHR that it showed to state inspectors, and a parallel paper record that hid violations of the state’s “timely access” law that mandates shorter wait times for mental healthcare than Kaiser was able to provide.  The inaccuracies involved in the HMO’s dual record keeping system meant that mental health patients may have waited weeks longer than the law stipulates for appointments, resulting in illegal denials of access to care for schizophrenia, autism, depression and suicidal ideation, among other serious conditions.

The problem stems from Kaiser’s double appointment keeping procedures.  While there is an electronic version – the version that gets reported to government officials – Kaiser also used paper lists in some facilities, rendering its electronic appointment wait time calculators useless.

The entire story is here.

Thanks to Ed Zuckerman for this story.

Proof That Obamacare 'Rate Shock' Is An Ugly Insurance Company Deception

By Rick Unger
Forbes - Op Ed
Originally published on March 26, 2013

Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.

At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.

As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.

Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.

The entire Op Ed is here.

The study debunking the "rate shock" rumor is here.

Thursday, March 28, 2013

Bringing a Virtual Brain to Life

By Tim Requarth
The New York Times
Originally published March 18, 2013

Here are some excerpts:

In 2009, Dr. Markram conceived of the Human Brain Project, a sprawling and controversial initiative of more than 150 institutions around the world that he hopes will bring scientists together to realize his dream.
In January, the European Union raised the stakes by awarding the project a 10-year grant of up to $1.3 billion — an unheard-of sum in neuroscience.
“A meticulous virtual copy of the human brain,” Dr. Markram wrote in Scientific American, “would enable basic research on brain cells and circuits or computer-based drug trials.”
An equally ambitious “big brain” idea is in the works in the United States: The Obama administration is expected to propose its own project, with up to $3 billion allocated over a decade to develop technologies to track the electrical activity of every neuron in the brain.
But just as many obstacles stand in the way of the American project, a number of scientists have expressed serious reservations about Dr. Markram’s project.
Some say we don’t know enough about the brain to simulate it on a supercomputer. And even if we did, these critics ask, what would be the value of building such a complicated “virtual brain”?


“It’s not like the Human Genome Project, where you just have to read out a few billion base pairs and you’re done,” said Peter Dayan, a neuroscientist at University College London. “For the human brain, what would you need to know to build a simulation? That’s a huge research question, and it has to do with what’s important to know about the brain.”
And Haim Sompolinsky, a neuroscientist at the Hebrew University of Jerusalem, said: “The rhetoric is that in a decade they will be able to reverse-engineer the human brain in computers. This is fantasy. Nothing will come close to it in a decade.”

New Guidelines Raise Safety Bar on Concussions

By Alan Mozes
Originally published March 18, 2013

Any athlete who suffers a suspected concussion should be withdrawn from play and stay on the sidelines until a qualified health care professional determines that all symptoms have subsided and it is safe to return to the field, new guidelines state.

Issued by the American Academy of Neurology, the latest recommendations aim to keep young athletes as safe as possible.

"With the older guidelines, we were trying to rate concussions at the time of the injury and predict recovery times, but now we know, 'When in doubt, sit 'em out,'" said guideline co-author Dr. Christopher Giza, an associate professor of pediatric neurology and neurosurgery with the David Geffen School of Medicine at the University of California, Los Angeles, and Mattel Children's Hospital.

"The point is that no single quick test is really a litmus test for a concussion," he said. "We know now that we need to make sure a player has had a thorough and proper evaluation, involving a symptoms checklist, a standardized assessment and balance and cognitive testing, before being returned to play. This evaluation has to be done on a case-by-case basis, so each person goes through an individualized recovery process."

Wednesday, March 27, 2013

How Does Technology Affect Business Ethics?

By Hans Fredrick

The more integrated a piece of technology becomes into the way we do business, the more the potential ethical conundrums posed by that technology become apparent. Ethical business practices need to grow and evolve in step with technology. While new devices and advances may make the day-to-day operations of running a business easier, they also create challenges that the ethical businessperson must contend with.


Privacy has become a much larger concern in the modern technological age. Business ethicists are still learning and debating how much privacy people are entitled to in the digital age, as are lawmakers. For instance, many employers had taken to the practice of requiring potential employees to provide them with the password to their Facebook pages. This opened up the door to potential privacy issues, not to mention discriminatory hiring practices. In 2012, a law was passed in California to prohibit this particular breach of privacy; but in some jurisdictions, the decision whether or not to ask for this information is still an ethical, rather than a legal matter.

The entire story is here.

Drones, Ethics and the Armchair Soldier

By John Kaag
The New York Times - Opinionator
Originally published on March 17, 2013

Here are some excerpts:

Ten years later, I’m a philosopher writing a book about the ethics of drone warfare. Some days I fear that I will have either to give up the book or to give up philosophy. I worry that I can’t have both. Some of my colleagues would like me to provide decision procedures for military planners and soldiers, the type that could guide them, automatically, unthinkingly, mechanically, to the right decision about drone use. I try to tell them that this is not how ethics, or philosophy, or humans, work.

I try to tell them that the difference between humans and robots is precisely the ability to think and reflect, in Immanuel Kant’s words, to set and pursue ends for themselves. And these ends cannot be set beforehand in some hard and fast way — even if Kant sometimes thought they could.

What disturbs me is the idea that a book about the moral hazard of military technologies should be written as if it was going to be read by robots: input decision procedure, output decision and correlated action. I know that effective military operations have traditionally been based on the chain of command and that this looks a little like the command and control structure of robots. When someone is shooting at you, I can only imagine that you need to follow orders mechanically. The heat of battle is neither the time nor the place for cool ethical reflection.

Warfare, unlike philosophy, could never be conducted from an armchair. Until now. For the first time in history, some soldiers have this in common with philosophers: they can do their jobs sitting down. They now have what I’ve always enjoyed, namely “leisure,” in the Hobbesian sense of the word, meaning they are not constantly afraid of being killed. Hobbes thought that there are certain not-so-obvious perks to leisure (not being killed is the obvious one). For one, you get to think. This is what he means when he says that “leisure is the mother of philosophy.” I tend to agree with Hobbes: only those who enjoy a certain amount of leisure can be philosophers.

The entire article is here.

Tuesday, March 26, 2013

Familiarity breeds doctor contempt with EHRs

Experts say meaningful use is contributing to the growth of electronic health record systems, but it also has a negative effect on EHR user-friendliness.

By Pamela Lewis Dolan
Originally published March 18, 2013

The meaningful use incentive program has resulted in more physicians implementing electronic health record systems and using them in advanced ways. Yet doctors' dissatisfaction with the systems has increased.

Theories for what is driving the dissatisfaction include rushed implementations, too little training and physicians doing too much too soon as they struggle to meet meaningful use requirements, other federal mandates and changes to the health care landscape. EHR vendors also are thought to be taking on too much in too little time. As they rush to deliver products certified for meaningful use, usability may have suffered.

A survey by AmericanEHR Partners of 4,279 clinicians, including primary care physicians, specialists and diagnostic professionals, found that user satisfaction declined from 39% in 2010 to 27% in 2012. The rate of those “very dissatisfied” increased from 11% to 21% during the same period. The findings were presented in March at the Healthcare Information and Management Systems Society annual conference in New Orleans.

After my daughter’s death, I work to prevent future deaths

By Martha Deed
Originally published March 17, 2013

Here are som excerpts:

Another disturbed and disturbing night. It doesn’t happen often three years later. Now – when it does happen – I generally know why.

I am preparing to make a presentation of a sentinel event from my daughter’s final illness to a group of medical professionals and patient advocates. Last night, I was working on key points. What issues seem most important for hospital staffs to address after these years of reflection?

I am convinced – have understood for some time – that the fundamental issue is not that my daughter is dead or even how she died. The basic issue is, “Can we learn anything to prevent future deaths?”
The conference presentation makes use of the past to inform the future. I am co-presenting with a chief medical officer of a hospital system in another state.

Recently, he asked me how I am able to do this – stare into the disaster, sort it out, convey a message of hope. He asks, “What separates people like me who work toward improving safe and competent care from people who cannot move beyond paralyzing grief and anger?”


My obligation as a parent and as a social scientist engaged in patient advocacy is to do what I can to help health care providers in their work. As a layperson, I can’t do much to improve patient outcomes; I have neither the education, nor the position to change anything within a hospital or medical office.

The entire blog entry is here.

Thanks to Ed Zuckerman for this information.

Monday, March 25, 2013

In Steubenville, why didn't other girls help?

By Rachel Simmons
Special to CNN
Originally posted March 21, 2013

Is anyone else wondering why the Steubenville, Ohio rape victim's two best friends testified against her? With this week's arrest of two other girls who "menaced" the teen victim on Facebook and Twitter, we have the beginnings of an answer.

Rape culture is not only the province of boys. The often hidden culture of girl cruelty can discourage accusers from coming forward and punish them viciously once they do. This week, two teenage boys were found guilty of raping a 16-year-old classmate while she was apparently drunk and passed out during a night of parties last August. Everyone who was there and said nothing that night was complicit; if we want to prevent another Steubenville, the role of other girls must also be considered.

On the night in question, girls watched the victim (Jane Doe) become so drunk she could hardly walk. Why didn't any of them help her? Why, after Jane Doe endured the agonizing experience of a trial in which she viewed widely circulated photos of herself naked and unconscious, did one of the arrested girls tweet: "you ripped my family apart, you made my cousin cry, so when I see you xxxxx, it's gone be a homicide." Why were two lifelong friends sitting on the other side of the courtroom?

The accusation of rape disrupts the intricate social ecosystem of a high school, one in which girls often believe that they must preserve both their own reputations and relationships with boys above all else. This is a process that begins for girls long before their freshman year and can have violent consequences.

The entire story is here.

Antipsychotic Use Skyrockets in America's Poorest Children

By Fran Lowry
Medscape Today News
Originally published March 12, 2013

Antipsychotic use among Medicaid-insured children from low- or very-low-income families skyrocketed in just under a decade, new research shows.

Investigators from the University of Maryland in Baltimore found that from 1997 to 2006, use of antipsychotic medications in this population increased 7- to 12-fold, with most of the increased use associated with treatment for behavioral problems.

"Awareness of the expanding use of antipsychotic medications in the emotional and behavioral treatment of children has been noted in several studies of community-based pediatric populations," lead author Julie Magno Zito, PhD, from the University of Maryland, told Medscape Medical News.

"But," she added, "additional information is needed on trends in our neediest youth, namely according to how antipsychotic users differ in terms of their eligibility for Medicaid insurance coverage and the reasons for use. Such information would help to characterize the 'who' and 'why' of expanded antipsychotic use."

The study is published in the March issue of Psychiatric Services.

The entire article is here.

Sunday, March 24, 2013

The Grounds of Moral Status

Stanford Encyclopedia of Philosophy
First published on March 14, 2013

An entity has moral status if and only if it or its interests morally matter to some degree for the entity's own sake, such that it can be wronged. For instance, an animal may be said to have moral status if its suffering is at least somewhat morally bad, on account of this animal itself and regardless of the consequences for other beings, and acting unjustifiably against its interests is not only wrong, but wrongs the animal. Others owe it to the animal to avoid acting in this way. Some philosophers think of moral status as coming in degrees, reserving the notion of full moral status (FMS) for the highest degree of status.

Sometimes the term “moral standing” rather than “moral status” is used, but typically these terms have the same meaning. Some philosophers employ the language of “moral considerability” but this term is extremely ambiguous. Some use it as an alternate expression for “moral status” which is understood to come in degrees. In other cases the phrase is used to mean FMS. Act Utilitarians employ yet a third notion of moral considerability, which is a matter of having one's interests (e.g., the intensity, duration, etc. of one's pleasure or pain) factored into the calculus to determine which action minimizes the bad and maximizes the good. To avoid these ambiguities, this entry will use the terminology of “moral status” and “FMS.” 

After reviewing which entities have been thought to have moral status and what is involved in having FMS, as opposed to a lesser degree of moral status, this article will survey different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

The entire article is here.

The Boundaries of the Moral (and Legal) Community

By Brian Leiter
The Expanding Moral Community
Alabama Law Review, Vol. 64(3), 511-531.

Let me invite you to step back from the parochial political disputes that dominate public life in America and most other modern democracies, as well as from the internecine academic quarrels characteristic of so much professionalized scholarship in the modern academy, and reflect, instead, on the broader sweep of moral and political thought, in both the philosophical and practical realm, over the past two or three hundred years.  What must immediately strike any observer of this period is the remarkable expansion it has witnessed of what I will henceforth call “the moral community,” that is, the community of creatures that are thought entitled to equal moral consideration, whatever the precise details of what such consideration involves—that is, whether it is a matter of showing “respect,” recognizing the “dignity” of each, or “maximizing the utility or well-being” of each, or some other formulation.  I am speaking here about our official ideologies and discourse, not necessarily all our actual practices and laws, though they gradually follow suit over the course of a century or so. But at the level of ideology, reflected in both ordinary moral opinion and in the work of philosophers, we in the West—ignorance of the relevant philosophical and legal traditions requires me to remain agnostic on the proverbial “East,” though the trends seem to be similar—have largely abandoned the ideas that gender, race, ethnicity, religion, class, and now even sexual orientation are morally relevant attributes in the sense that they are attributes that determine the basic moral consideration to which one is entitled. To be sure, in particular contexts, these characteristics may matter because of the context. So, for example, I take it most would still think it morally unproblematic to consider race in casting the lead role in Shakespeare’s Othello, and most of us would still think it morally unproblematic that a man contemplating marriage gives some consideration to the gender or religion of his potential mate. 

The entire article is here.

Saturday, March 23, 2013

Suit claims Pa. prison system inflicts cruel, unusual punishment on mentally ill

By Maiken Scott
Originally published March 11, 2013

The Disability Rights Network is suing the Pennsylvania Department of Corrections, claiming that housing seriously mentally ill prisoners in solitary confinement is unconstitutional.

In the lawsuit, the advocacy organization claims about 800 Pennsylvania prisoners with severe mental illnesses are incarcerated in "restricted housing units," where they dwell in small, single cells for at least 23 hours a day, with the lights on the entire time. The suit calls this cruel and unusual punishment.


Pennsylvania's Department of Corrections would not comment on the suit, but officials said that of the state's 51,300 prisoners, about 20 percent are known to have mental health issues.

The entire article is here.

Psychiatrist, Also Victimized, Tells of Attack by Defendant

By Russ Buettner
The New York Times
Originally published March 12, 2013

At the murder trial of a man accused of killing an Upper East Side psychologist, several mental health experts are expected to testify about the defendant’s state of mind on the night of the slaying. But one of those experts, Dr. Kent D. Shinbach, did not come to his conclusions from the comfort of his desk.

Dr. Shinbach’s appraisal came to him as he was lying not far from a dead or dying colleague, looking up at a former patient, David Tarloff, who was wielding a bloody meat cleaver.

“He was entirely focused on the task at hand,” Dr. Shinbach, a psychiatrist, testified on Tuesday in State Supreme Court in Manhattan.

Dr. Shinbach, 75, shared an office suite with the dead psychologist, Kathryn Faughey. Mr. Tarloff’s lawyers are not contesting that he stabbed and slashed Ms. Faughey, 56, to death on Feb. 12, 2008. They are seeking to prove he was not responsible because of his mental illness.

The entire article is here.

Friday, March 22, 2013

New Hampshire's mental health system: From leader to failure

By Annmarie Timmins
The Concord Monitor
Originally published March 10, 2013

During his 1971 inaugural address, then-Gov. Walter Peterson identified seven goals for his next term. First on the Republican’s list was improving mental health care.

Peterson wanted to stop warehousing people with mental illness at the state’s psychiatric hospital and begin treating them in local communities. “A state mental institution,” Peterson told lawmakers 42 years ago, “is, more than anything else, a symbol of failure to help people in time.”

Two decades later, the state had become a national leader in mental health care by beginning what Peterson had envisioned. Lawmakers had established 10 community mental health centers and put money into local housing and local treatment. And under the leadership of then-Gov. John H. Sununu, the state had opened a modern 316-bed state hospital in place of the 19th-century-era institution, once called the New Hampshire Asylum for the Insane, that had housed nearly 2,000 people.

At the time, Donald Shumway, then director of the state’s Division of Mental Health, said the national recognition showed “our plan is really heading in the right direction.”

The acclaim would be short-lived.

Today, everyone from mental health advocates to lawmakers to Gov. Maggie Hassan describe the state’s mental health system as broken.

In a scathing 2011 critique, the federal government said mental health care here is “in crisis.” Federal officials accused the state of violating the Americans with Disabilities Act by starving the community care system in favor of unnecessary hospitalization. Last year, several patients made the same allegation in a federal lawsuit against the state that the federal government has joined.

Meanwhile, people in crisis languish in emergency rooms, sometimes for days, waiting for a hospital bed. The state’s jails and prisons have become the new mental health “‘asylum,” with an estimated 65 percent of the state prison population having a mental illness, according to a prison spokesman.

The entire article is here.

At Penn State, Academics Drive Effort to Hire Child-Abuse Experts

By Robin Wilson
The Chronicle of Higher Education
Originally published March 11, 2013

When the Jerry Sandusky child sex-abuse scandal broke, in 2011, professors at Pennsylvania State University were as shocked as anyone else. Then they did what faculty members often do: They set about formulating an academic response to the horrifying incidents, some of which had occurred on their own University Park campus.

The result is a campaign to hire over the next three years a dozen faculty members whose work focuses on child abuse and entails cutting-edge research, clinical treatment, and public education about the problem. The hiring is on a fast track: The university just opened six searches and hopes to have a half-dozen new tenured and tenure-track hires on campus by next fall.

The entire story is here.

8th grade student commits suicide in school

WXYZ.com Action News
Originally published March 21, 2013

Southgate Community Schools superintendent Bill Grusecki says an eighth grade student committed suicide Thursday morning at Davidson Middle School.

Police say the boy was found in a restroom before classes began at about 8:15 a.m. Another student discovered the boy and alerted a teacher. Staff members immediately stepped in and called police.

The boy was transported to a hospital where he died.

The student died from a self-inflicted gunshot wound to the head. Police say he had a .40-caliber handgun. Police are not releasing the boy's name until family has had time to notify all relatives.

Then entire tragic story is here.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

Thursday, March 21, 2013

Spiritual Care and Moral Injury in Service Members

By George F. Handzo
Caring Connections
Volume 10, Number 1
Winter 2013

Here are some excerpts:

It is important to note that moral injury has been widely discussed in several contexts, including sexual assault and the provision of health care—the latter being mainly in the nursing literature. While there are significant overlaps in cause, symptoms and spiritual interventions, moral injury in the military is focused on and arises from the particular context of the service member’s involvement in combat. In the military, moral injury is most often talked about as a subcategory of PTSD although, as I will discuss below, this can be a misleading characterization.


Moral Injury:

The behavioral, cognitive, and emotional aftermath of unreconciled severe moral conflict, withdrawal, and self-condemnation. It closely mirrors re-experiencing, avoidance, and emotional numbing symptoms of PTSD.   Unlike life-threat trauma, moral injury may also include: self-harming behaviors, such as poor self-care, alcohol and drug abuse, severe recklessness, and parasuicidal behavior, self-handicapping behaviors, such as retreating in the face of success or good feelings, and demoralization, which may entail confusion, bewilderment, futility, hopelessness, and self-loathing. (Litz, B, et al, 2009)

Moral Distress:

The painful psychological disequilibrium that results from recognizing the ethically appropriate action, yet not taking it, because of such obstacles as lack of time, supervisory reluctance, an inhibiting power structure, institution policy, or chain of command considerations (Corley et al., 2001) (Thus, moral distress in this context is largely a symptom of moral injury).


The result of exposure to events so overwhelmingly stressful and extraordinary that anyone who experiences them would be distressed. In the experience of the ma, the person usually fears for his or her life or the lives of others. This triggering traumatic event overwhelms the person’s ability to respond or cope adequately. For normal diagnostic purposes, PTSD has four components – the stressor, re-experiencing, avoidance, and hyper-arousal.   All four components must be present for a diagnosis of PTSD.

The entire article is here.

Thanks to Gary Schoener for the article.

The Winter Issue of Caring Connections is entitled Light in the Darkness: Hope, Resilience and Moral Injury and has several articles related to moral injury.

Report rebuts claim that ACA is unfair to young adults

A Robert Wood Johnson Foundation/Urban Institute analysis says health system reform's coverage provisions will help mitigate the effect of setting new age rating bands.

By Jennifer Lubell
Originally published March 18, 2013

An Affordable Care Act provision that seeks to limit the amount by which insurance premiums can vary based on enrollees' ages won't result in young adults paying unreasonably high premiums, an analysis has concluded.

The impact of the ACA's new formula for setting age rating bands has attracted recent interest in Washington. Starting in 2014 under the law, insurers will be prohibited from selling nongroup coverage to an adult 64 or older for more than three times the premium they would assign to a 21-year-old for the same coverage. This translates into a maximum 3-to-1 premium ratio based on age, which narrows the gap between what younger and older people pay for insurance now.
A Robert Wood Johnson Foundation report prepared by the Urban Institute acknowledges that tighter ratios will lead to increased premiums for younger adults and lower premiums for older adults. However, the study projects that other ACA coverage provisions will mitigate the negative effects that young people may experience from the new age rating bands.

Wednesday, March 20, 2013

'Shameful' failure to tackle slavery and human trafficking in the UK

Inquiry outlines 80 recommendations, including appointing an independent commissioner and new legislation to protect victims

By Toby Helm and Mark Townsend
The Guardian/The Observer
Originally published on March 9, 2013

Ministers, the police and social workers have been accused of a "shocking" failure to prevent the spread of modern slavery in the UK, leading to sexual exploitation, forced labour and the domestic servitude of adults and children from across the world.

Describing government ministers as "clueless" in their response to tackling human trafficking, both into and within the UK, the most exhaustive inquiry yet conducted into the phenomenon concludes that the approach to eradicating modern slavery is fundamentally wrong-headed. Instead of helping vulnerable victims who are trapped into forms of slavery after being trafficked from overseas, the legal system prosecutes many for immigration offences.

The major study by the Centre for Social Justice, which will be published on Monday, says that political indifference and ignorance alongside a leadership vacuum in Whitehall has meant that the country that led the way in abolishing slavery in the 19th century is now a "shameful shadow" of its former self as the practice makes a comeback in a contemporary guise.

The entire story is here.

Tuesday, March 19, 2013

UnitedHealth Sued by Over Mental Health-Care Access

By Christie Smythe
Bloomberg News
Originally published March 11, 2013

UnitedHealth Group Inc. (UNH) was sued by the New York State Psychiatric Association and mental-health patients over claims the insurer violated laws barring unequal coverage for psychiatric conditions.

UnitedHealth, the second-largest U.S. health insurer, has maintained “unjustifiably stringent medical-necessity criteria and pre-authorization requirements for mental-health services,” the plaintiffs said in a complaint filed today in federal court in Manhattan.

The company denied or limited access to psychotherapy and other mental-health treatments for patients suffering from conditions including psychosis, chronic depression, and anxiety disorders, according to the 102-page complaint, which seeks to represent all customers of the company facing similar situations.

The entire article is here.

The World's Most Ethical Companies

By Jacquelyn Smith
Originally published March 1, 2013

The Ethisphere Institute, an international think tank, has just announced its seventh annual list of the World’s Most Ethical Companies. The selection, open to every company in every industry around the globe, gives its winners an opportunity to trumpet their do-gooding ways. It is not a ranking, so they are all equally winners.


Why is there so much interest? Brigham says that recognition on the WME list has proven to be beneficial in various ways for the winners. “Many companies promote the recognition in their recruitment materials, as studies show that employees increasingly want to work for an organization that aligns with their own personal values. They are more loyal to such organizations,” he says. “In addition to providing a competitive advantage in workforce recruitment, many companies also display the designation in their marketing materials to attract customers, particularly in new markets,  where the company may not be well-known.”

The World’s Most Ethical Companies are leaders of their respective industries when it comes to key ethical criteria such as tone from the top, employee well-being, CSR, compliance programs and other important areas, Brigham adds. “Every year we are impressed to learn some of the new ethics initiatives that these companies have developed and we are pleased to see the bar raised higher year after year. These companies also understand that a strong culture of ethics is also key to helping drive financial performance,” he concludes.

The entire article, including the winners, is here.

Monday, March 18, 2013

Film Festival Explores an Ugly Medical Chapter

By Barron H. Lerner
The New York Times
Originally published March 7, 2013

A film festival dedicated to stories about people with disabilities kicks off this week in New York City. The event, called “ReelAbilities,” is mostly a celebration of people with different abilities, but one troubling new film explores a particularly dark chapter of medical history.

The award-winning short film, “Willowbrook,” to be screened Friday at New York University Langone Medical Center, examines an unthinkable medical experiment: researchers injected active hepatitis virus into healthy children with mental disabilities.

The story of Willowbrook began in 1947, when New York State converted a hospital into a residential facility that was supposed to house 4,000 children. By the mid-1960s, however, the Willowbrook State School on Staten Island, contained more than 6,000 children. The situation was abominable, with children lining the corridors, many unclothed and lying in their own excrement. It is little wonder that then-Senator Robert F. Kennedy called Willowbrook a “snake pit” after a 1965 tour. An exposé of the brutal conditions by a young television reporter named Geraldo Rivera in 1972 led to government inquiries and the eventual closing of the institution — but not for another 15 years.

The entire story is here.

A trailer for Willowbrook is below.

Overhaul of Rules for Human Research Hits Impasse

By Paul Basken
The Chronicle of Higher Education
Originally published March 7, 2013

After months of trying to reconcile the sometimes competing goals of making the rules both simpler and tougher, while engaging 17 different federal agencies affected by the Common Rule, participants are describing the process as stalemated.

"I think it's dead, pretty much," said E. Greg Koski, a former director of the human-research-protections office, reflecting assessments he's heard from key players in the process.

The office has a published timetable suggesting it will formally propose a new set of regulations next month. In a written statement, the current director of the Office for Human Research Protections, Jerry A. Menikoff, said he intended to keep trying.

"This is, of course, a complicated undertaking, as was stated from the outset, and it takes time," Dr. Menikoff said.

The entire story, including The Chronicle's paywall, is here.

Sunday, March 17, 2013

Suicide, With No Warning

By Elisabeth Rosenthal
The New York Times - Sunday Review
Originally published March 8, 2013

Here are some excerpts:

But more than 60 percent of gun-related deaths in the United States are suicides, like Mr. Lewiecki’s. Reducing that statistic will most likely take different interventions than are currently proposed — like waiting periods and safe storage requirements — and those are not even on the table.

While background checks might turn up people with severe mental illness who have been prone to violence, gun suicides are often committed by people whose history doesn’t suggest a serious problem. In studies, a quarter to a third of those who killed themselves were not in contact with a psychiatrist at the time of death, and the majority were not on psychiatric medicines. “The first time the family may know of the distress is when they kill themselves,” said Dr. David Gunnell, a suicide epidemiologist at the University of Bristol in England. There may be no red flags and little forethought. To carry out a campus killing rampage, perpetrators collect weapons, identify victims and select locations. In contrast, suicides are often solitary, impulsive acts, experts say.

That is why a cornerstone of suicide prevention is simple: “restricting access to common and particularly lethal means for everyone — we know that’s effective,” said Dan Reidenberg, executive director of SAVE (Suicide Awareness and Voices of Education), a national suicide prevention group.

That means different things in different places. In Britain, suicide prevention efforts in the late 1990s involved banning the sales of large bottles of paracetamol (known as Tylenol in the United States), which had been used in tens of thousands of suicide attempts each year. When I was reporting from China a decade ago, rural officials responded to an epidemic of suicide among women by restricting pesticide sales.

In the United States, we build barriers on bridges, but have fewer barriers to the quick access to guns: “In the U.S. one of the most straightforward things to do to prevent suicide is to make firearms less accessible,” Dr. Gunnell said. The Lewiecki family believes that Kerry might well be alive if there had been a waiting period before purchase in Oregon. Studies suggest that far fewer American teenagers would commit suicide if gun owners were required to use trigger locks. Seventy-five percent of the guns used in youth suicides and unintentional injuries were accessible in the home or the home of a friend.

The entire story is here.

James Holmes' Attorneys: Colorado Insanity Pleas Are Unconstitutional

By Dan Elliott
The Associated Press
Originally published March 6, 2013

Prosecutors in the deadly Colorado movie theater shooting are disputing defense arguments that the state law on insanity pleas is unconstitutional.

In court documents made public Wednesday, prosecutors said the statute has been upheld in other cases, and that judges have ways to protect defendants' rights.

Lawyers for suspect James Holmes filed motions last week asking the judge in the case to declare the law unconstitutional because it would require Holmes' attorneys to give prosecutors potentially incriminating information, such as mental health records, if he pleads not guilty by reason of insanity.

The defense said that violates Holmes' rights, including Fifth Amendment protections against self-incrimination. They said defendants who simply plead not guilty are not required to turn over such information.

The entire story is here.

Saturday, March 16, 2013

How Mom’s Death Changed My Thinking About End-of-Life Care

By Charles Ornstein
ProPublica – Co-published with The Washington Post
Originally published February 28, 2013

Here are some excerpts:

I've long observed, and sometimes chronicled, the nasty policy battles surrounding end-of-life care. And like many health journalists, I rolled my eyes when I heard the phrase "death panels" used to describe a 2009 congressional proposal that would have allowed Medicare to reimburse physicians who provided counseling to patients about living wills and advance directives. The frenzy, whipped up by conservative politicians and talk show hosts, forced the authors of the Affordable Care Act to strip out that provision before the bill became law.

Politics aside, I've always thought that the high cost of end-of-life care is an issue worthy of discussion. About a quarter of Medicare payments are spent in the last year of life, according to recent estimates. And the degree of care provided to patients in that last year — how many doctors they see, the number of intensive-care hospitalizations — varies dramatically across states and even within states, according to the authoritative Dartmouth Atlas.

Studies show that this care is often futile. It doesn't always prolong lives, and it doesn't always reflect what patients want.

In an article I wrote for the Los Angeles Times in 2005, I quoted a doctor saying: "There's always one more treatment, there's always one more, 'Why don't we try that?' ... But we have to realize what the goals of that patient are, which is not to be in an intensive-care unit attached to tubes with no chance of really recovering."

Friday, March 15, 2013

Vignette 23: A Simple Request

Dr. Smith was treating Mrs. Drapier for depression precipitated, in part, by a separation and pending divorce. There were contentious issues dealing with the custody arrangements of the children. A court appointed custody evaluator performed a child custody evaluation. Among other things, the report contained a psychological evaluation of the patient.

Mrs. Drapier thought it would be good for Dr. Smith to review the report in order to help him with their therapy.  Mrs. Drapier read the report and admitted that she did not understand some of the psychological jargon used in the report and had difficulty understanding what the conclusions of the report were.

Dr. Smith decided to review the report.  He believed that the custody evaluator had made several significant errors in the report concerning the psychological health of his patient.  Additionally, Dr. Smith believed that some of the conclusions were in error, and had little support for those opinions in the body of the report.

Prior to their next session, Dr. Smith calls you for a consultation. 

Dr. Smith asked if he needed to inform the patient of his impressions of the report and the seemingly erroneous conclusions.  He feels stuck between being faithful to the patient and her needs without crossing a boundary as a treating psychologist.

He also wondered if he should contact the patient’s lawyer, with her permission, to disclose his perceptions about the quality of the report and his perceptions about the conclusions.

Dr. Smith also wondered if it was appropriate to bill Mrs. Drapier for his time in reviewing the report.

Dr. Smith also asked if it is ethical to bill the patient’s insurance company to review his impressions of a forensic report during a psychotherapy session. 

Thursday, March 14, 2013

Survey: Too many EHR alerts could lead to missing test results

By Andis Robeznieks
Originally posted March 4, 2013

The information deluge unleashed by electronic health-record systems could cause physicians to miss notifications of abnormal test results, according to a survey of primary-care practitioners with the U.S. Veterans Affairs Department. Missing those notifications could delay needed care for patients, according to the physicians, nurse practitioners and physicians assistants surveyed.

Researchers from several Houston institutions—including the Houston VA Health Services Research and Development Center of Excellence—surveyed almost 2,600 VA primary-care practitioners from June 2010 through November 2010 regarding EHR-based alerts. Almost 30% acknowledged missing notification of test results that led to care delays, according to a research letter in the American Medical Association journal JAMA Internal Medicine (formerly the Archives of Internal Medicine).

The entire story is here.

Book Review: Against Absolute Goodness

By Nomy Arpaly
Notre Dame - Philosophical Review: An Electronic Journal
Book Review: Against Absolute Goodness by Richard Kraut

The obligatory joke -- this book is very good, but not absolutely so -- has essentially been made already in a blurb on the cover. In the blurb, Russ Shafer Landau says the book is excellent, and I have to agree it is. It is also very well written. With its lucid prose -- rare in a philosophy book -- it can be read in one sitting.

Kraut defends the view that there is neither absolute goodness nor absolute badness. By this he does not mean that Hitler is not an absolutely morally hideous person, nor does he mean that, as one's undergraduate students are fond of saying, it's all subjective. Kraut means that nothing should be called "good, period" or "simply good". A thing can only be good for someone or good of a kind. Thus a thing can be objectively and noninstrumentally good or bad for a person or any other creature to whose well being it makes sense to refer. Different things can be objectively, noninstrumentally good for different creatures -- I am reminded of Spinoza declaring that music is good to the melancholy, bad to those who mourn, and neither good nor bad to the deaf -- but some things might be bad for a lot of creatures -- some kinds of pain are perhaps bad for all sentient beings. A thing can also be a good of a kind. For example, a thing can be a good toaster or a good tennis player. The good tennis player is not a person who possesses two qualities -- the property of being good and the property of being a tennis player (though Moore might want us to believe he does). She is a person who is good qua tennis player. Unlike other thinkers he cites, like Geach and Thomson, Kraut does not think that saying that something is "good, period" or "just plain good" is an abuse of language. He just claims that, like phlogiston, absolute goodness simply is not there, and that, just like in the case of phlogiston, it can be shown by pointing to all the work the concept of absolute goodness cannot do as well as the work it does not need to do because other concepts do it better.

The entire book review is here.

Wednesday, March 13, 2013

No Scientific Basis for Prohibiting Same-Sex Marriage, Key Associations Argue

Leading mental health groups file briefs in Supreme Court cases challenging Defense of Marriage Act, California’s Proposition 8

American Psychological Association
Press Release
Released on March 1, 2013

There is no valid scientific basis for denying same-sex couples the right to legal marriage, or to deprive them of considerable benefits of the institution, according to legal briefs filed with the U.S. Supreme Court by the American Psychological Association and other leading mental health associations.

“Empirical research demonstrates that the psychological and social aspects of committed relationships between same-sex partners largely resemble those of heterosexual partnerships,” the briefs state. “Like heterosexual couples, same-sex couples form deep emotional attachments and commitments. Heterosexual and same-sex couples alike face similar issues concerning intimacy, love, equity, loyalty and stability, and they go through similar processes to address those issues.”

Denying recognition to legally married same-sex couples stigmatizes them, according to the “friend of the court” briefs filed in the cases of Hollingsworth v. Perry, which challenges California’s Proposition 8, and U.S. v. Windsor, which challenges the federal Defense of Marriage Act. Perry is slated to be argued before the court on March 26; Windsor will be argued on March 27.

The briefs cite empirical scientific evidence that demonstrate that “homosexuality is a normal expression of human sexuality, is generally not chosen and is highly resistant to change.” Likewise, “there is no scientific basis for concluding that gay and lesbian parents are any less fit or capable than heterosexual parents, or that their children are any less psychologically healthy and well-adjusted,” according to the briefs.

The entire release is here.

Replicate This

Do classic psychological studies published in high-profile journals hold up? The Reproducibility Project aims to find out.

By Kayt Sukel
Pacific Standard Magazine
Originally published on February 26, 2013

There are few psychological effects better known—or more widely accepted—in academic halls than what is called semantic priming. Show a person a simple stimulus, something as unremarkable as a photograph of a cat. Let some time pass, then ask that same person to list as many words as possible that start with the letter c. This person is more likely not only to come up with the word cat, but to mention catlike animals such as cougars and cheetahs, because he was initially primed with that one little kitty cat.

Priming’s reach, of course, stretches far beyond cognitive tests. Therapists use it to help treat patients with depression during therapy sessions. Advertisers count on commercials to prime us to buy key brands during our trips to the mall or the grocery store. Priming is considered an underlying mechanism in stereotyping. And the word has become part of our cultural lexicon, too. We talk about how we are “primed” to feel, to want, to need, to talk. Priming is everywhere.

And yet, many of the classic studies that led us to our current understanding of priming have never been replicated. In fact, the few attempts to reproduce the results that we have taken at face value for so long have failed. In late 2012, that led Daniel Kahneman, noted Princeton University psychologist and author of the best-selling book Thinking Fast and Slow, to write an open e-mail to the entire priming-research community. He wrote, “Your field is now the poster child for doubts about the integrity of psychological research. Your problem is not with the few people who have actively challenged the validity of some priming results. It is with the much larger population of colleagues who in the past accepted your surprising results as facts when they were published.” Kahneman’s solution? A new research protocol whereby cooperating labs attempt to check and replicate each other’s studies. This is the only way, he argues, to separate the scientific wheat from the chaff.

The entire article is here.

Tuesday, March 12, 2013

Slaying the Messenger?

By Allie Grasgreen
Inside Higher Ed
Originally published February 26, 2013

Landen Gambill took an unusual step after she was sexually assaulted.

She reported it.

Unusual why? Because the vast majority of rapes go unreported.

But now Gambill is the one on trial. The student-run Honor Court at the University of North Carolina at Chapel Hill informed her last week that it’s charging her with violation of the Honor Code under a statute prohibiting “Disruptive or intimidating behavior that willfully abuses, disparages, or otherwise interferes with another….  so as to adversely affect their academic pursuits, opportunities for university employment, participation in university-sponsored extracurricular activities, or opportunities to benefit from other aspects of University Life.”

In other words, as the court told Gambill, she could get expelled for saying she was raped.

The entire article is here.

Ethics of Admission, Pt. II: Undergraduates and the Brass Ring

By Jane Robbins
Inside Higher Ed
Originally posted February 26, 2013

Here are some excerpts:

But what about students? Is it worth the chance at the brass ring? One could say there is no choice but get on the merry-go-round—and that is certainly what they are being told. But if we know that many will not get a shot because of where they are placed or when they got on or whether, metaphorically, they lack the height compared to the one behind them to reach the ring, is the current approach wrong—in both the incorrect and immoral senses of the word?

The inevitable is, of course, happening: people are beginning to question the value of a college degree for them as individuals. This is why, counterintutively, the push for the current wage data approach to value is completely wrong-headed and also, I think unethical. It is the individual that has been lost in the wholesale approach to commodity credentials and wage comparison, a particularly perverse kind of educational “channeling.” In the service of whose interests is, for example, the tireless emphasis on STEM and the disparagement of arts? Who will care when large percentages with STEM credentials can’t find jobs, experience depressed wages because there are so many of them, and find themselves with no transferable skills or habits of mind when technology moves on? If it is going to be difficult to find a job anyway, one should at least have followed one’s own interests. Education should allow you to choose your work, not vice versa.

On the constant merry-go-round, we seem to have forgotten that college, or any other education at any level except technical and some forms of professional education, is not to get a job, and certainly not to get a particular job. That is what trade school is for. We should be encouraging students who want a particular job -- a vocation -- to train elsewhere, perhaps with the idea of getting more and broader education at a later time.

The rest of the blog post is here.

Monday, March 11, 2013

It's time for psychologists to put their house in order

BMC Psychology pledges 'to put less emphasis on interest levels' and publish repeat studies and negative results

By Keith Laws
The Guardian, Notes & Theories
Originally published February 27, 2013

In 2005, the epidemiologist John Ioannidis provocatively claimed that "most published research findings are false". In the field of psychology – where negative results rarely see the light of day – we have a related problem: there is the very real possibility that many unpublished, negative findings are true.

Psychologists have an aversion to some essential aspects of science that they perceive to be unexciting or less valuable. Historically, the discipline has done almost nothing to ensure the reliability of findings through the publication of repeat studies and negative ("null") findings.

Psychologists find significant statistical support for their hypotheses more frequently than any other science, and this is not a new phenomenon. More than 30 years ago, it was reported that psychology researchers are eight times as likely to submit manuscripts for publication when the results are positive rather than negative.

Unpublished, "failed" replications and negative findings stay in the file-drawer and therefore remain unknown to future investigators, who may independently replicate the null-finding (each also unpublished) - until by chance, a spuriously significant effect turns up.

The entire story is here.

Why Failing Med Students Don’t Get Failing Grades

By Pauline Chen
The New York Times
Originally published February 28, 2013

Here are some excerpts:

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be.

The entire story is here.

Sunday, March 10, 2013

Protecting Patient Privacy and Data Security

By Julie K. Taitsman, Christi Macrina Grimm, and Shantanu Agrawal
The New England Journal of Medicine - Perspective
February 27, 2013
DOI: 10.1056/NEJMp1215258

Here is one portion of the article.


• Install and enable encryption
• Use a password or other user authentication
• Install and activate wiping, remote disabling, or both to erase data on lost or stolen devices
• Disable and do not install or use file-sharing applications
• Install and enable a firewall to block unauthorized access
• Install and enable security software to protect against malicious applications, viruses, spyware, and  malware-based attacks
• Keep security software up to date
• Research mobile applications before downloading
• Maintain physical control of mobile devices
• Use adequate security to send or receive health information over public Wi-Fi networks
• Delete all stored health information on mobile devices before discarding the devices

* Recommended by the Office of the National Coordinator for Health Information Technology

The entire article is here.

Thanks to Gary Schoener for this article.

Ethics in the age of acceleration

By Vivek Wadhwa
The Washington Post
Originally posted July 13, 2013

Here are some excerpts:

Advances in technology are changing who we are and what we are. Today’s bio-engineered devices and exoskeletons are just a start. Over time, they will become larger components of our bodies, playing more critical roles. As the Glenn case on human-machine mergers shows, modern-day business practices lack an understanding of changes in technology.

But this is the tip of the iceberg. Preeta Bansal says that law and ethics, too, lag behind advances in technology. Bansal is the former White House general counsel and senior policy Advisor and prior to that served as Solicitor General of the state of New York. For example, she asks, how will existing rules of liability be applied when a self-driving car, such as the autonomous vehicle Google is designing, hits a pedestrian? Will robotic devices with attributes of human sentience be subject to criminal laws – either as victims or perpetrators? To what extent will individuals have the right to control the collection, maintenance, dissemination, and accessibility of private information?

The entire story is here.

It's Hard to Gross Out a Libertarian

The NYU psychologist on sex and the culture war
By Jim Epstein
Originally published on February 26, 2013


“Morality isn’t just about stealing and killing and honesty, it’s often about menstruation, and food, and who you are having sex with, and how you handle corpses,” says NYU social psychologist Jonathan Haidt, who is author of The Righteous Mind: Why Good People are Divided by Politics.

Saturday, March 9, 2013

Inadequate Ethics Training Leaves Young Scientists Unprepared for "Ethical Emergencies"

By Beryl Benderly
Science Careers Blog
Originally published July 14, 2013

Difficult ethical issues can present significant challenges to graduate students and early-career scientists, but few receive adequate training and guidance in dealing with these problems, agreed a panel of experts at the Euroscience Open Forum (ESOF) 2012 in Dublin. Formal training in ethics was unknown in science before 1990, when it became a requirement in the United States, said Nicholas Steneck of the University of Michigan, who is a consultant to the Federal Office of Research Integrity. In recent years, he continued, interest has increased in other countries as well. Concepts of ethics and responsible research vary among countries and disciplines, however, the speakers agreed, and there is no uniformity in the content of training even within countries. And, although various initiatives are underway in a variety of nations, nowhere is training sufficient to the needs of young researchers, the panelists said.

The competitive pressures that young scientists face today are much more severe than in the past and can make ethical problems more acute, said Maria Leptin of the European Molecular Biology Organization (EMBO) in Germany and the Initiative for Science in Europe. Today's intense competition greatly increases incentive to produce the maximum number of publications and to have one's name on as many papers as possible.

The entire story is here.

Ethics of 2 cancer studies questioned

India studies funded by Gates Foundation, National Cancer Institute draw scrutiny

By Bob Ortega
The Republic
Originally posted February 15, 2013

For more than 12 years, as part of two massive U.S-funded studies in India, researchers tracked a large group of women for cervical cancer but didn’t screen them, instead monitoring them as their cancers progressed. At least 79 of the women died.

One study, funded by the National Cancer Institute, did not adequately inform more than 76,000 women taking part about their alternatives for getting cervical-cancer screening; and those women did not give adequate informed consent, according to the Office of Human Research Protection, part of the U.S. Department of Health and Human Services.

The other study, funded by the Gates Foundation, is under review by the Food and Drug Administration, according to Kristina Borror, the OHRP’s director of compliance oversight. That study has raised similar concerns regarding 31,000 women who were tracked but not routinely screened or treated for cervical cancer.

Both studies continue today, though researchers for both told The Arizona Republic they have begun to offer screening to the women.

While the two studies differ in important respects, both included large numbers of women placed in “control groups” who were offered free visits with health-care workers, but who, until recently,were not screened for cervical cancer. Instead, researchers met with and tracked these women to monitor how many would develop cervical cancer and die, so their death rates could be compared with those of women who were being screened and treated for free.

The entire story is here.

Friday, March 8, 2013

Evaluations of Dangerousness among those Adjudicated Not Guilty by Reason of Insanity

Edited by Christina M. Finello, JD, PhD
American Psychology Law Society
Winter 2013 News

In many states, following an indeterminate period of hospitalization, individuals adjudicated Not Guilty by Reason of Insanity (hereafter called “acquittees” despite different international legal terminology) are typically discharged under conditional release with provisions for ongoing monitoring and recommitment (Packer & Grisso, 2011). Studies have identified factors associated with conditional release, recommitment, and reoffending in this population. However, few studies have evaluated whether risk assessment measures could assist in predicting recommitment to forensic hospitals.

A number of static factors may be associated with decisions to retain or conditionally release acquittees. For example, Callahan and Silver (1998) found that female acquittees, those with diagnoses other than Schizophrenia and those who committed non-violent offenses, were released most often. Additionally, low psychopathy and older age during one’s first criminal offense increased the likelihood of release (Manguno-Mire, Thompson, BertmanPate, Burnett, & Thompson, 2007). Dynamic and protective variables also influence decisions of retention versus release. For example, researchers identified that acquittees’ treatment compliance and responsiveness, substance use, risk of violence, and availability of structured activities in the community are relevant to release decisions (McDermott, Edens, Quanbeck, Busse, & Scott, 2008; Stredny, Parker, & Dibble, 2012).

Decisions regarding release versus retention involve determinations of future dangerousness (Jones v. United States, 1983), highlighting the relevance of violence risk assessment measures. However, available data do not indicate a strong relationship between scores on risk assessment measures and dispositional decisions. For example, McKee, Harris, and Rice (2007) observed that scores on the Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, 1998) predicted clinicians’ recommendations for retention versus transfer from a maximum security facility, but did not predict the ultimate decisions. Côté, Crocker, Nicholls, and Seto (2012) reported that, with the exception of previous violence, presence of major mental illness, substance use problems, active symptoms of major mental illness, and unresponsiveness to treatment - the factors of the Historical, Clinical, Risk Management-20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997) identified by researchers - corresponded poorly (if at all) with those raised by evaluators in review hearings.

The entire article can be found here.

Why the Ethics of Parsimonious Medicine Is Not the Ethics of Rationing

By Jon C. Tilburt and Christine Cassel
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.

The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.

Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.

Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care.  Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.

The entire article is here.

Thursday, March 7, 2013

Hitler's Philosophers, By Yvonne Sherratt

This book tells the disturbing and important story of how major thinkers abetted genocide

By John Gray - Book Review
The Independent
Originally published February 23, 2013

The only German philosophy professor who actively resisted the Nazis is nowadays virtually unknown. Though one or two scholarly monographs have appeared on him, Kurt Huber will not be found on any university syllabus. The silence that has swallowed his name and his works is almost as complete as that which followed when, after being stripped of his university post and doctoral degree by a Nazi People's Court, he was executed by guillotine in July 1943 for writing a pamphlet against National Socialism as a member of the White Rose resistance group.

A conservative Catholic who produced a classic study of Leibniz and made important contributions to aesthetics and musicology, Huber is today not much more than a footnote in history. When Yvonne Sherratt writes, "Huber's intellectual prowess remains as quiet in the Western world as it was under Hitler", she hardly exaggerates.

In contrast, some active collaborators with the Nazis feature among the most celebrated names of post-war philosophy. Serving the Nazis for a time as a university rector, Martin Heidegger cut off relations with Edmund Husserl, the Jewish philosopher who had secured his professorship, removing the dedication to Husserl from Being and Time (Heidegger's principal work) and failing either to visit his mentor when he was dying or attend his funeral in 1938. As a result of the intellectual campaign waged by his former student and lover Hannah Arendt, and support form prominent figures such as Jean-Paul Sartre, Heidegger succeeded in becoming one of the most influential of late 20th-century philosophers.

The entire review is here.

Stanford experiment shows that virtual superpowers encourage real-world empathy

Giving test subjects Superman-like flight in a virtual reality simulator makes them more likely to exhibit altruistic behavior in real life, Stanford researchers find.

By Bjorn Carey
The Stanford Report
Originally published January 31, 2013

If you give people superpowers, will they use those abilities for good?

Researchers at Stanford recently investigated the subject by giving people the ability of Superman-like flight in the university's Virtual Human Interaction Laboratory (VHIL). While several studies have shown that playing violent videogames can encourage aggressive behavior, the new research suggests that games could be designed to train people to be more empathetic in the real world.


"It's very clear that if you design games that are violent, peoples' aggressive behavior increases," Bailenson said. "If we can identify the mechanism that encourages empathy, then perhaps we can design technology and video games that people will enjoy and that will successfully promote altruistic behavior in the real world."

The entire article is here.

Thanks to Ed Zuckerman for a lead on this article.

Wednesday, March 6, 2013

War zone killing: Vets feel 'alone' in their guilt

Associated Press
Originally published February 22, 2013

A veteran of the wars in Iraq and Afghanistan, former Marine Capt. Timothy Kudo thinks of himself as a killer — and he carries the guilt every day.

"I can't forgive myself," he says. "And the people who can forgive me are dead."

With American troops at war for more than a decade, there's been an unprecedented number of studies into war zone psychology and an evolving understanding of post-traumatic stress disorder. Clinicians suspect some troops are suffering from what they call "moral injuries" — wounds from having done something, or failed to stop something, that violates their moral code.

Though there may be some overlap in symptoms, moral injuries aren't what most people think of as PTSD, the nightmares and flashbacks of terrifying, life-threatening combat events. A moral injury tortures the conscience; symptoms include deep shame, guilt and rage. It's not a medical problem, and it's unclear how to treat it, says retired Col. Elspeth Ritchie, former psychiatry consultant to the Army surgeon general.

The entire story is here.

Perspectives on Suicide in the Army National Guard

By James Griffith & Mark Vaitkus
Armed Forces & Society published online 22 February 2013


Suicides in the US military were observed rising in 2004, most notably in the Army and Marine Corps, and particularly, in the Army National Guard (ARNG). Alarmed, Army leaders and researchers have offered various explanations and prescriptions, often lacking any evidence. In the present study, three data sets were used to examine evidence for various perspectives on suicide—dispositional risk, social
cognitive, stressor-strain, and social cultural/institutional, each having different emphases on relevant explanatory variables and underlying mechanisms of suicide. Primary risk factors associated with having committed suicide among the 2007–2010 ARNG suicide cases were age (young), gender (male), and race (white), supporting the dispositional risk perspective on suicide. Some evidence supported the stressor-strain perspective in that postdeployment loss of a significant other and a
major life change showed statistically significant, yet weaker associations with increased suicide intentions. Implications of results are discussed for future research and preventive strategies.

Here is part of the discussion:

Military-related variables, including having been deployed and combat exposure, showed little relationship to suicide. These findings are consistent with analyses of the active component Army suicides. US Army Public Health Command has consistently reported suicide cases as occurring disproportionally among males, Caucasians, younger in age (eighteen to twenty-four years), and often having an untreated behavioral condition and/or substance abuse.

The entire journal article is here.

Tuesday, March 5, 2013

Bitter Pill: Why Medical Bills Are Killing Us

By Steven Brill
Time: Health & Fitness
Originally published February 20, 2013

Here are some excerpts:

I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

The entire story is here.

Sale of personal gene data condemned as 'unethical and dangerous'

Critics say companies could acquire personal information that would identify NHS patients without their consent

By Jaime Doward
The Observer
Originally published February 16, 2013

Private firms will soon be able to buy people's medical and genetic data without their consent and, in certain cases, acquire personal information that might enable them to identify individuals.

The revelation, which contradicts government claims that such material would be completely anonymous, has raised fears that pharmaceutical firms and insurance companies will be able to determine the identities of people susceptible to particular diseases. It has prompted claims that fundamental changes to the use of NHS patient data are being introduced without adequate public debate or regulatory oversight.

The government is keen for Britain to be at the forefront of the genetic revolution, a potential multibillion-pound industry. Last year David Cameron launched a £100m scheme to map the genomes of up to 100,000 people, saying it would help to save lives by delivering new treatments. The move was seen as the first step in the construction of a national human genome database.

Under the scheme, firms would be able to access the information at a cost, but ministers insist that all data will be strictly anonymous. However, material released under the Freedom of Information Act reveals that firms can invoke an appeal process to demand "patient-identifiable data", such as age and postcode.

The entire story is here.

Monday, March 4, 2013

Anti-human-trafficking efforts gain momentum

New policies and new laws on human trafficking are spreading across several states

By Yamiche Alcindor
Originally posted on February 16, 2013

A growing wave of efforts to stop human trafficking has spread across the country as lawmakers and others look to combat the problem through law, policy, and grass-roots activism.

While approaches vary, advocates say more must be done to stop the crime, dubbed "modern day slavery" and defined by the U.S. State Department as the recruitment, transportation or harboring of people by means of deception or coercion. Victims, often mentally and physically abused, can be forced into prostitution, unfair working conditions, or other exploitative situations.

"Consciousness and outrage have reached a different level because of the perverseness but also the impact of human trafficking," said Sen. Richard Blumenthal, D-Conn. "People understand that everyone has a responsibility to fight human trafficking and every individual can have an impact."

The entire story is here.

Advocates Seek Mental Health Changes, Including Power to Detain

The Texas Tribune/The New York Times
Published: February 23, 2013

Here are some excerpts:

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.


Hospital officials say they face a Catch-22 under current law: if they detain a mentally ill person against his or her will, they face liability because they have no legal authority to do so. If they allow the person to leave and something tragic happens, they risk a lawsuit like the one the Boren family filed.

The entire story is here.