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, October 17, 2018

Huge price hikes by drug companies are immoral

Robert Klitzman
CNN.com
Originally posted September 18, 2018

Several pharmaceutical companies have been jacking up the prices of their drugs in unethical ways. Most recently, Nirmal Mulye, founder and president of Nostrum Pharmaceuticals, defended his decision to more than quadruple the price of nitrofurantoin, used to treat bladder infections, from about $500 to more than $2,300 a bottle. He said it was his "moral requirement to sell the product at the highest price."

Mulye argues that his only moral duty is to benefit his investors. As he said in defending Martin Shkreli, who in 2015 raised the price of an anti-parasite drug, daraprim, 5,000% from $13.50 to $750 per tablet, "When he raised the price of his drug he was within his rights because he had to reward his shareholders."

Mulye is wrong for many reasons. Drug companies deserve reasonable return on their investment in research and development, but some of these companies are abusing the system. The development of countless new drugs depends on taxpayer money and sacrifices that patients in studies make in good faith. Excessive price hikes harm many people, threaten public health and deplete huge amounts of taxpayer money that could be better used in other ways.

The US government pays more than 40% of all Americans' prescription costs, and this amount has been growing faster than inflation. In 2015, over 118 million Americans were on some form of government health insurance, including around 52 million on Medicare and 62 million on Medicaid. And these numbers have been increasing. Today, around 59 million Americans are on Medicare and 75 million on Medicaid.

The info is here.

Machine Ethics and Artificial Moral Agents

Francesco Corea
Medium.com
Originally posted July 6, 2017

Here is an excerpt:

However, let’s look at the problem from a different angle. I was educated as an economist, so allow me to start my argument with this statement: let’s assume we have the perfect dataset. It is not only omni-comprehensive but also clean, consistent and deep both longitudinally and temporally speaking.

Even in this case, we have no guarantee AI won’t learn the same bias autonomously as we did. In other words, removing biases by hand or by construction is not a guarantee of those biases to not come out again spontaneously.

This possibility also raises another (philosophical) question: we are building this argument from the assumption that biases are bad (mostly). So let’s say the machines come up with a result we see as biased, and therefore we reset them and start again the analysis with new data. But the machines come up with a similarly ‘biased result’. Would we then be open to accepting that as true and revision what we consider to be biased?

This is basically a cultural and philosophical clash between two different species.

In other words, I believe that two of the reasons why embedding ethics into machine designing is extremely hard is that i) we don’t really know unanimously what ethics is, and ii) we should be open to admit that our values or ethics might not be completely right and that what we consider to be biased is not the exception but rather the norm.

Developing a (general) AI is making us think about those problems and it will change (if it hasn’t already started) our values system. And perhaps, who knows, we will end up learning something from machines’ ethics as well.

The info is here.

Tuesday, October 16, 2018

Let's Talk About AI Ethics; We're On A Deadline

Tom Vander Ark
Forbes.com
Originally posted September 13, 2018

Here is an excerpt:

Creating Values-Aligned AI

“The project of creating value-aligned AI is perhaps one of the most important things we will ever do,” said the Future of Life Institute. It’s not just about useful intelligence but “the ends to which intelligence is aimed and the social/political context, rules, and policies in and through which this all happens.”

The Institute created a visual map of interdisciplinary issues to be addressed:

  • Validation: ensuring that the right system specification is provided for the core of the agent given stakeholders' goals for the system.
  • Security: applying cyber security paradigms and techniques to AI-specific challenges.
  • Control: structural methods for operators to maintain control over advanced agents.
  • Foundations: foundational mathematical or philosophical problems that have bearing on multiple facets of safety
  • Verification: techniques that help prove a system was implemented correctly given a formal specification
  • Ethics: effort to understand what we ought to do and what counts as moral or good.
  • Governance: the norms and values held by society, which are structured through various formal and informal processes of decision-making to ensure accountability, stability, broad participation, and the rule of law.

Nudge or Grudge? Choice Architecture and Parental Decision‐Making

Jennifer Blumenthal‐Barby and Douglas J. Opel
The Hastings Center Report
Originally published March 28, 2018

Abstract

Richard Thaler and Cass Sunstein define a nudge as “any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates’ decision‐making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision‐making in the context of pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well‐known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics.

We argue that there is an even stronger ethical justification for nudging in parental decision‐making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision‐making authority; (2) nudging can help fulfill pediatric clinicians’ obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents’ decisional burden regarding what is best for their child, particularly with decisions that have implications for public health.

The info is here.

Monday, October 15, 2018

ICP Ethics Code

Institute of Contemporary Psychoanalysis

Psychoanalysts strive to reduce suffering and promote self-understanding, while respecting human dignity. Above all, we take care to do no harm. Working in the uncertain realm of unconscious emotions and feelings, our exclusive focus must be on safeguarding and benefitting our patients as we try to help them understand their unconscious mental life. Our mandate requires us to err on the side of ethical caution. As clinicians who help people understand the meaning of their dreams and unconscious longings, we are aware of our power and sway. We acknowledge a special obligation to protect people from unintended harm resulting from our own human foibles.

In recognition of our professional mandate and our authority—and the private, subjective and influential nature of our work—we commit to upholding the highest ethical standards. These standards take the guesswork out of how best to create a safe container for psychoanalysis. These ethical principles inspire tolerant and respectful behaviors, which in turn facilitate the health and safety of our candidates, members and, most especially, our patients. Ultimately, ethical behavior protects us from ourselves, while preserving the integrity of our institute and profession.

Professional misconduct is not permitted, including, but not limited to dishonesty, discrimination and boundary violations. Members are asked to keep firmly in mind our core values of personal integrity, tolerance and respect for others. These values are critical to fulfilling our mission as practitioners and educators of psychoanalytic therapy. Prejudice is never tolerated whether on the basis of age, disability, ethnicity, gender, gender identity, race, religion, sexual orientation or social class. Institute decisions (candidate advancement, professional opportunities, etc.) are to be made exclusively on the basis of merit or seniority. Boundary violations, including, but not limited to sexual misconduct, undue influence, exploitation, harassment and the illegal breaking of confidentiality, are not permitted. Members are encouraged to seek consultation readily when grappling with any ethical or clinical concerns. Participatory democracy is a primary value of ICP. All members and candidates have the responsibility for knowing these guidelines, adhering to them and helping other members comply with them.

The ethics code is here.

Big Island considers adding honesty policy to ethics code

Associated Press
Originally posted September 14, 2018

Big Island officials are considering adding language to the county's ethics code requiring officers and employees to provide the public with information that is accurate and factual.

The county council voted last week in support of the measure, requiring county employees to provide honest information to "the best of each officer's or employee's abilities and knowledge," West Hawaii Today reported . It's set to go before council for final approval next week.

The current measure has changed from Puna Councilwoman Eileen O'Hara's original bill that simply stated "officers and employees should be truthful."

She introduced the measure in response to residents' concerns, but amended it to gain the support of her colleagues, she said.

The info is here.

Sunday, October 14, 2018

The Myth of Freedom

Yuval Noah Harari
The Guardian
Originally posted September 14, 2018

Here is an excerpt:

Unfortunately, “free will” isn’t a scientific reality. It is a myth inherited from Christian theology. Theologians developed the idea of “free will” to explain why God is right to punish sinners for their bad choices and reward saints for their good choices. If our choices aren’t made freely, why should God punish or reward us for them? According to the theologians, it is reasonable for God to do so, because our choices reflect the free will of our eternal souls, which are independent of all physical and biological constraints.

This myth has little to do with what science now teaches us about Homo sapiens and other animals. Humans certainly have a will – but it isn’t free. You cannot decide what desires you have. You don’t decide to be introvert or extrovert, easy-going or anxious, gay or straight. Humans make choices – but they are never independent choices. Every choice depends on a lot of biological, social and personal conditions that you cannot determine for yourself. I can choose what to eat, whom to marry and whom to vote for, but these choices are determined in part by my genes, my biochemistry, my gender, my family background, my national culture, etc – and I didn’t choose which genes or family to have.

This is not abstract theory. You can witness this easily. Just observe the next thought that pops up in your mind. Where did it come from? Did you freely choose to think it? Obviously not. If you carefully observe your own mind, you come to realise that you have little control of what’s going on there, and you are not choosing freely what to think, what to feel, and what to want.

Though “free will” was always a myth, in previous centuries it was a helpful one. It emboldened people who had to fight against the Inquisition, the divine right of kings, the KGB and the KKK. The myth also carried few costs. In 1776 or 1945 there was relatively little harm in believing that your feelings and choices were the product of some “free will” rather than the result of biochemistry and neurology.

But now the belief in “free will” suddenly becomes dangerous. If governments and corporations succeed in hacking the human animal, the easiest people to manipulate will be those who believe in free will.

The info is here.

Saturday, October 13, 2018

A Top Goldman Banker Raised Ethics Concerns. Then He Was Gone.

Emily Flitter, Kate Kelly and David Enrich
The New York Times
Originally posted September 11, 2018

By the tight-lipped standards of Goldman Sachs, the phone call from one of the firm’s most senior investment bankers was explosive.

James C. Katzman, a Goldman partner and the leader of its West Coast mergers-and-acquisitions practice, dialed the bank’s whistle-blower hotline in 2014 to complain about what he regarded as a range of unethical practices, according to accounts by people close to Mr. Katzman, which a Goldman spokesman confirmed. His grievances included an effort by Goldman to hire a customer’s child and colleagues’ repeated attempts to obtain and then share confidential client information.

Mr. Katzman expected lawyers at the firm Fried, Frank, Harris, Shriver & Jacobson, which monitored the hotline, to investigate his allegations and share them with independent members of Goldman’s board of directors, the people close to Mr. Katzman said.

The complaints were an extraordinary example of a senior employee’s taking on what he perceived to be corporate wrongdoing at an elite Wall Street bank. But they were never independently investigated or fully relayed to the Goldman board.

The information is here.

Friday, October 12, 2018

The New Standardized Morality Test. Really.

Peter Greene
Forbes - Education
Originally published September 13, 2018

Here is an excerpt:

Morality is sticky and complicated, and I'm not going to pin it down here. It's one thing to manage your own moral growth and another thing to foster the moral development of family and friends and still quite another thing to have a company hired by a government draft up morality curriculum that will be delivered by yet another wing of the government. And it is yet another other thing to create a standardized test by which to give students morality scores.

But the folks at ACT say they will "leverage the expertise of U.S.-based research and test development teams to create the assessment, which will utilize the latest theory and principles of social and emotional learning (SEL) through the development process." That is quite a pile of jargon to dress up "We're going to cobble together a test to measure how moral a student is. The test will be based on stuff."

ACT Chief Commercial Officer Suzana Delanghe is quoted saying "We are thrilled to be supporting a holistic approach to student success" and promises that they will create a "world class assessment that measures UAE student readiness" because even an ACT manager knows better than to say that they're going to write a standardized test for morality.

The info is here.

Americans Are Shifting The Rest Of Their Identity To Match Their Politics

Perry Bacon Jr.
www.fivethirtyeight.com
Originally posted September 11, 2018

Here is an excerpt:

In a recently published book, the University of Pennsylvania’s Michele Margolis makes a case similar to Egan’s, specifically about religion: Her research found, for example, that church attendance by Democrats declined between 2002 and 2004, when then-President Bush and Republicans were emphasizing Bush’s faith and how it connected to his opposition to abortion and gay marriage.

I don’t want to overemphasize the results of these studies. Egan still believes that the primary dynamic in politics and identity is that people change parties to match their other identities. But I think Egan’s analysis is in line with a lot of emerging political science that finds U.S. politics is now a fight about identity and culture (and perhaps it always was). Increasingly, the political party you belong to represents a big part of your identity and is not just a reflection of your political views. It may even be your most important identity.

Asked what he thinks the implications of his research are, Egan said that he shies away from saying whether the results are “good or bad.” “I don’t think one kind of identity (say ethnicity or religion) is necessarily more authentic than another (e.g., ideology or party),” he said in an email to FiveThirtyEight.

The info is here.

This information is very important to better understand your patients and identity development.

Thursday, October 11, 2018

Pharma exec had 'moral requirement' to raise price 400%

Wayne Drash
CNN.com
Originally published September 12, 2018

 A pharmaceutical company executive defended his company's recent 400% drug price increase, telling the Financial Times that his company had a "moral requirement to sell the product at the highest price." The head of the US Food and Drug Administration blasted the executive in a response on Twitter.

Nirmal Mulye, founder and president of Nostrum Pharmaceuticals, commented in a story Tuesday about the decision to raise the price of an antibiotic mixture called nitrofurantoin from about $500 per bottle to more than $2,300. The drug is listed by the World Health Organization as an "essential" medicine for lower urinary tract infections.

"I think it is a moral requirement to make money when you can," Mulye told the Financial Times, "to sell the product for the highest price."

The info is here.

Does your nonprofit have a code of ethics that works?

Mary Beth West
USA Today Network - Tennessee
Originally posted September 10, 2018

Each year, the Public Relations Society of America recognizes September as ethics month.

Our present #FakeNews / #MeToo era offers a daily diet of news coverage and exposés about ethics shortfalls in business, media and government sectors.

One arena sometimes overlooked is that of nonprofit organizations.

I am currently involved in a national ethics-driven bylaw reform movement for PRSA itself, which is a 501(c)(6) nonprofit with 21,000-plus members globally, in the “business league” category.

While PRSA’s code of ethics has stood for decades as an industry standard for communications ethics – promoting members’ adherence to only truthful and honest practices – PRSA’s code is not enforceable.

Challenges with unenforced ethics codes

Unenforced codes of ethics are commonplace in the nonprofit arena, particularly for volunteer, member-driven organizations.

PRSA converted from its enforced code of ethics to one that is unenforced by design, nearly two decades ago.

The reason: enforcing code compliance and the adjudication processes inherent to it were a pain in the neck (and a pain in the wallet, due to litigation risks).

The info is here.

Wednesday, October 10, 2018

Psychologists Are Standing Up Against Torture at Gitmo

Rebecca Gordon
theNation.com
Originally posted September 11, 2018

Sometimes the good guys do win. That’s what happened on August 8 in San Francisco when the Council of Representatives of the American Psychological Association (APA) decided to extend a policy keeping its members out of the US detention center at Guantánamo Bay, Cuba.

The APA’s decision is important—and not just symbolically. Today we have a president who has promised to bring back torture and “load up” Guantánamo “with some bad dudes.” When healing professionals refuse to work there, they are standing up for human rights and against torture.

It wasn’t always so. In the early days of Guantánamo, military psychologists contributed to detainee interrogations there. It was for Guantánamo that Defense Secretary Donald Rumsfeld approved multiple torture methods, including among others excruciating stress positions, prolonged isolation, sensory deprivation, and enforced nudity. Military psychologists advised on which techniques would take advantage of the weaknesses of individual detainees. And it was two psychologists, one an APA member, who designed the CIA’s whole “enhanced interrogation program.”

The info is here.

Urban Meyer, Ohio State Football, and How Leaders Ignore Unethical Behavior

David Mayer
Harvard Business Review
Originally posted September 4, 2018

Here is an excerpt:

A sizable literature in management and psychology helps us understand how people become susceptible to moral biases and make choices that are inconsistent with their values and the values of their organizations. Reading the report with that lens can help leaders better understand the biases that get in the way of ethical conduct and ethical organizations.

Performance over principles. One number may surpass all other details in this case: 90%. That’s the percentage of games the team has won under Meyer as head coach since he joined Ohio State in 2012. Psychological research shows that in almost every area of life, being moral is weighted as more important than being competent. However, in competitive environments such as work and sports, the classic findings flip: competence is prized over character. Although the report does not mention anything about the team’s performance or the resulting financial and reputational benefits of winning, the program’s success may have crowded out concerns over the allegations against Smith and about the many other problematic behaviors he showed.

Unspoken values. Another factor that can increase the likelihood of making unethical decisions is the absence of language around values. Classic research in organizations has found that leaders tend to be reluctant to use “moral language.” For example, leaders are more likely to talk about deadlines, objectives, and effectiveness than values such as integrity, respect, and compassion. Over time, this can license unethical conduct.

The info is here.

Tuesday, October 9, 2018

Morality is the new profit – banks must learn or die

Zoe Williams
The Guardian
Originally posted September 10, 2018

Here is an excerpt:

Ten years ago, “ethical” investing meant not buying shares in arms and alcohol, as if morality were so unfamiliar to financial decision-making that you had to go back to the 19th century and borrow it from the Quakers. The growth of banks with a moral mission – like Triodos (“quality of life, human dignity, sustainability”) – or investments with a social purpose – like Abundance, which finances renewable energy – has been impressive on its own terms, but remained niche, for baby boomers with a conscience. The idea that all market activity should have a purpose other than profit is roughly where it always was on the spectrum, somewhere between Marx and Jesus – one for the rioters, the subversives, the people with beards, unsuited to mainstream discourse.

But there is nothing more pragmatic and less idealistic than to insist on the social purpose of the market; banking cannot survive without it – not as a corporate bolt-on but as its driving and decisive motivation. The derivatives trade cannot weather the consequences of infinite self-interest, because there really will be consequences – extreme global ones. The planet cannot survive an endless cost-benefit analysis in which nature is pitted against profit. Nature will always lose and so will humanity as a result. Whatever the immediate cause of the next crash, if and when it comes its roots will be environmental. The Financial Times talks about “the insidious danger that pension funds deflate, leaving a generation without enough money to retire”. The most likely cause for that devaluation of pensions – leaving aside the generation that cannot afford to save for the future – will be stranded assets, pension funds having invested in fossil fuels that cannot be excavated.

The info is here.

Top Cancer Researcher Fails to Disclose Corporate Financial Ties in Major Research Journals

Charles Ornstein and Katie Thomas
The New York Times
Originally published September 8, 2018

One of the world’s top breast cancer doctors failed to disclose millions of dollars in payments from drug and health care companies in recent years, omitting his financial ties from dozens of research articles in prestigious publications like The New England Journal of Medicine and The Lancet.

The researcher, Dr. José Baselga, a towering figure in the cancer world, is the chief medical officer at Memorial Sloan Kettering Cancer Center in New York. He has held board memberships or advisory roles with Roche and Bristol-Myers Squibb, among other corporations, has had a stake in start-ups testing cancer therapies, and played a key role in the development of breakthrough drugs that have revolutionized treatments for breast cancer.

According to an analysis by The New York Times and ProPublica, Dr. Baselga did not follow financial disclosure rules set by the American Association for Cancer Research when he was president of the group. He also left out payments he received from companies connected to cancer research in his articles published in the group’s journal, Cancer Discovery. At the same time, he has been one of the journal’s two editors in chief.

The info is here.

Monday, October 8, 2018

Purpose, Meaning and Morality Without God

Ralph Lewis
Psychology Today Blog
Originally posted September 9, 2018

Here is an excerpt:

Religion is not the source of purpose, meaning and morality. Rather, religion can be understood as having incorporated these natural motivational and social dispositions and having coevolved with human cultures over time. Unsurprisingly, religion has also incorporated our more selfish, aggressive, competitive, and xenophobic human proclivities.

Modern secular societies with the lowest levels of religious belief have achieved far more compassion and flourishing than religious ones.

Secular humanists understand that societal ethics and compassion are achieved solely through human action in a fully natural world. We can rely only on ourselves and our fellow human beings. All we have is each other, huddled together on this lifeboat of a little planet in this vast indifferent universe.

We will need to continue to work actively toward the collective goal of more caring societies in order to further strengthen the progress of our species.

Far from being nihilistic, the fully naturalist worldview of secular humanism empowers us and liberates us from our irrational fears, and from our feelings of abandonment by the god we were told would take care of us, and motivates us to live with a sense of interdependent humanistic purpose. This deepens our feelings of value, engagement, and relatedness. People can and do care, even if universe doesn’t.

The blog post is here.

Evolutionary Psychology

Downes, Stephen M.
The Stanford Encyclopedia of Philosophy (Fall 2018 Edition), Edward N. Zalta (ed.)

Evolutionary psychology is one of many biologically informed approaches to the study of human behavior. Along with cognitive psychologists, evolutionary psychologists propose that much, if not all, of our behavior can be explained by appeal to internal psychological mechanisms. What distinguishes evolutionary psychologists from many cognitive psychologists is the proposal that the relevant internal mechanisms are adaptations—products of natural selection—that helped our ancestors get around the world, survive and reproduce. To understand the central claims of evolutionary psychology we require an understanding of some key concepts in evolutionary biology, cognitive psychology, philosophy of science and philosophy of mind. Philosophers are interested in evolutionary psychology for a number of reasons. For philosophers of science —mostly philosophers of biology—evolutionary psychology provides a critical target. There is a broad consensus among philosophers of science that evolutionary psychology is a deeply flawed enterprise. For philosophers of mind and cognitive science evolutionary psychology has been a source of empirical hypotheses about cognitive architecture and specific components of that architecture. Philosophers of mind are also critical of evolutionary psychology but their criticisms are not as all-encompassing as those presented by philosophers of biology. Evolutionary psychology is also invoked by philosophers interested in moral psychology both as a source of empirical hypotheses and as a critical target.

The entry is here.

Sunday, October 7, 2018

Transparency in Algorithmic and Human Decision-Making: Is There a Double Standard?

Zerilli, J., Knott, A., Maclaurin, J. et al.
Philos. Technol. (2018).

Abstract

We are sceptical of concerns over the opacity of algorithmic decision tools. While transparency and explainability are certainly important desiderata in algorithmic governance, we worry that automated decision-making is being held to an unrealistically high standard, possibly owing to an unrealistically high estimate of the degree of transparency attainable from human decision-makers. In this paper, we review evidence demonstrating that much human decision-making is fraught with transparency problems, show in what respects AI fares little worse or better and argue that at least some regulatory proposals for explainable AI could end up setting the bar higher than is necessary or indeed helpful. The demands of practical reason require the justification of action to be pitched at the level of practical reason. Decision tools that support or supplant practical reasoning should not be expected to aim higher than this. We cast this desideratum in terms of Daniel Dennett’s theory of the “intentional stance” and argue that since the justification of action for human purposes takes the form of intentional stance explanation, the justification of algorithmic decisions should take the same form. In practice, this means that the sorts of explanations for algorithmic decisions that are analogous to intentional stance explanations should be preferred over ones that aim at the architectural innards of a decision tool.

The article is here.

Saturday, October 6, 2018

Certainty Is Primarily Determined by Past Performance During Concept Learning

Louis Martí, Francis Mollica, Steven Piantadosi and Celeste Kidd
Open Mind: Discoveries in Cognitive Science
Posted Online August 16, 2018

Abstract

Prior research has yielded mixed findings on whether learners’ certainty reflects veridical probabilities from observed evidence. We compared predictions from an idealized model of learning to humans’ subjective reports of certainty during a Boolean concept-learning task in order to examine subjective certainty over the course of abstract, logical concept learning. Our analysis evaluated theoretically motivated potential predictors of certainty to determine how well each predicted participants’ subjective reports of certainty. Regression analyses that controlled for individual differences demonstrated that despite learning curves tracking the ideal learning models, reported certainty was best explained by performance rather than measures derived from a learning model. In particular, participants’ confidence was driven primarily by how well they observed themselves doing, not by idealized statistical inferences made from the data they observed.

Download the pdf here.

Key Points: In order to learn and understand, you need to use all the data you have accumulated, not just the feedback on your most recent performance.  In this way, feedback, rather than hard evidence, increases a person's sense of certainty when learning new things, or how to tell right from wrong.

Fascinating research, I hope I am interpreting it correctly.  I am not all that certain.

Friday, October 5, 2018

Nike picks a side in America’s culture wars

Andrew Edgecliffe-Johnson
Financial Times
Originally posted September 7, 2018

Here is an excerpt:

This is Nike’s second reason to be confident: drill down into this week’s polls and they show that support for Nike and Kaepernick is strongest among millennial or Gen-Z, African-American, liberal urbanites — the group Nike targets. The company’s biggest risk is becoming “mainstream, the usual, everywhere, tamed”, Prof Lee says. Courting controversy forces its most dedicated fans to defend it and catches the eye of more neutral consumers.

Finally, Nike will have been encouraged by studies showing that consumers reward brands for speaking up on divisive social issues. But it is doing something more novel and calculated than other multinationals that have weighed in on immigration, gun control or race: it did not stumble into this controversy; it sought it.

A polarised populace is a fact of life for brands, in the US and beyond. That leaves them with a choice: try to carry on catering to a vanishing mass-market middle ground, or stake out a position that will infuriate one side but excite the other. The latter strategy has worked for politicians such as Mr Trump. Unlike elected officials, a brand can win with far less than 50.1 per cent of the population behind it. (Nike chief executive Mark Parker told investors last year that it was looking to just 12 global cities to drive 80 per cent of its growth.)

The info is here.

Should Artificial Intelligence Augment Medical Decision Making? The Case for an Autonomy Algorithm

Camillo Lamanna and Lauren Byrne
AMA J Ethics. 2018;20(9):E902-910.

Abstract

A significant proportion of elderly and psychiatric patients do not have the capacity to make health care decisions. We suggest that machine learning technologies could be harnessed to integrate data mined from electronic health records (EHRs) and social media in order to estimate the confidence of the prediction that a patient would consent to a given treatment. We call this process, which takes data about patients as input and derives a confidence estimate for a particular patient’s predicted health care-related decision as an output, the autonomy algorithm. We suggest that the proposed algorithm would result in more accurate predictions than existing methods, which are resource intensive and consider only small patient cohorts. This algorithm could become a valuable tool in medical decision-making processes, augmenting the capacity of all people to make health care decisions in difficult situations.

The article is here.

Thursday, October 4, 2018

7 Short-Term AI ethics questions

Orlando Torres
www.towardsdatascience.com
Originally posted April 4, 2018

Here is an excerpt:

2. Transparency of Algorithms

Even more worrying than the fact that companies won’t allow their algorithms to be publicly scrutinized, is the fact that some algorithms are obscure even to their creators.
Deep learning is a rapidly growing technique in machine learning that makes very good predictions, but is not really able to explain why it made any particular prediction.

For example, some algorithms haven been used to fire teachers, without being able to give them an explanation of why the model indicated they should be fired.

How can we we balance the need for more accurate algorithms with the need for transparency towards people who are being affected by these algorithms? If necessary, are we willing to sacrifice accuracy for transparency, as Europe’s new General Data Protection Regulation may do? If it’s true that humans are likely unaware of their true motives for acting, should we demand machines be better at this than we actually are?

3. Supremacy of Algorithms

A similar but slightly different concern emerges from the previous two issues. If we start trusting algorithms to make decisions, who will have the final word on important decisions? Will it be humans, or algorithms?

For example, some algorithms are already being used to determine prison sentences. Given that we know judges’ decisions are affected by their moods, some people may argue that judges should be replaced with “robojudges”. However, a ProPublica study found that one of these popular sentencing algorithms was highly biased against blacks. To find a “risk score”, the algorithm uses inputs about a defendant’s acquaintances that would never be accepted as traditional evidence.

The info is here.

Shouldn’t We Make It Easy to Use Behavioral Science for Good?

Manasee Desai
www.behavioralscientist.org
Originally posted September 4, 2018

The evidence showing that applied behavioral science is a powerful tool for creating social good is growing rapidly. As a result, it’s become much more common for the world’s problem solvers to apply a behavioral lens to their work. Yet this approach can still feel distant to the people trying urgently to improve lives on a daily basis—those working for governments, nonprofits, and other organizations that directly tackle some of the most challenging and pervasive problems facing us today.

All too often, effective strategies for change are either locked behind paywalls or buried in inaccessible, jargon-laden articles. And because of the sheer volume of behavioral solutions being tested now, even people working in the fields that compose the behavioral sciences—like me, for instance—cannot possibly stay on top of every new intervention or application happening across countless fields and countries. This means missed opportunities to apply and scale effective interventions and to do more good in the world.

As a field, figuring out how to effectively report and communicate what we’ve learned from our research and interventions is our own “last mile” problem.

While there is no silver bullet for the problems the world faces, the behavioral science community should (and can) come together to make our battle-tested solutions available to problem solvers, right at their fingertips. Expanding the adoption of behavioral design for social good requires freeing solutions from dense journals and cost-prohibitive paywalls. It also requires distilling complex designs into simpler steps—uniting a community that is passionate about social impact and making the world a better place with applied behavioral science.

That is the aim of the Behavioral Evidence Hub (B-Hub), a curated, open-source digital collection of behavioral interventions proven to impact real-world problems.

The info is here.

Wednesday, October 3, 2018

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis.

Maria Panagioti, PhD; Keith Geraghty, PhD; Judith Johnson, PhD; et al
JAMA Intern Med. Published online September 4, 2018.
doi:10.1001/jamainternmed.2018.3713

Abstract

Importance  Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.

Objective  To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

Data Sources  MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

Data Extraction and Synthesis  Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

Main Outcomes and Measures  The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

Results  Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

Conclusions and Relevance  This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

The research is here.

Moral Reasoning

Richardson, Henry S.
The Stanford Encyclopedia of Philosophy (Fall 2018 Edition), Edward N. Zalta (ed.)

Here are two brief excerpts:

Moral considerations often conflict with one another. So do moral principles and moral commitments. Assuming that filial loyalty and patriotism are moral considerations, then Sartre’s student faces a moral conflict. Recall that it is one thing to model the metaphysics of morality or the truth conditions of moral statements and another to give an account of moral reasoning. In now looking at conflicting considerations, our interest here remains with the latter and not the former. Our principal interest is in ways that we need to structure or think about conflicting considerations in order to negotiate well our reasoning involving them.

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Understanding the notion of one duty overriding another in this way puts us in a position to take up the topic of moral dilemmas. Since this topic is covered in a separate article, here we may simply take up one attractive definition of a moral dilemma. Sinnott-Armstrong (1988) suggested that a moral dilemma is a situation in which the following are true of a single agent:

  1. He ought to do A.
  2. He ought to do B.
  3. He cannot do both A and B.
  4. (1) does not override (2) and (2) does not override (1).

This way of defining moral dilemmas distinguishes them from the kind of moral conflict, such as Ross’s promise-keeping/accident-prevention case, in which one of the duties is overridden by the other. Arguably, Sartre’s student faces a moral dilemma. Making sense of a situation in which neither of two duties overrides the other is easier if deliberative commensurability is denied. Whether moral dilemmas are possible will depend crucially on whether “ought” implies “can” and whether any pair of duties such as those comprised by (1) and (2) implies a single, “agglomerated” duty that the agent do both A and B. If either of these purported principles of the logic of duties is false, then moral dilemmas are possible.

The entry is here.

Tuesday, October 2, 2018

For the first time, researchers will release genetically engineered mosquitoes in Africa

Ike Swetlitz
www.statnews.com
Originally posted September 5, 2018

The government of Burkina Faso granted scientists permission to release genetically engineered mosquitoes anytime this year or next, researchers announced Wednesday. It’s a key step in the broader efforts to use bioengineering to eliminate malaria in the region.

The release, which scientists are hoping to execute this month, will be the first time that any genetically engineered animal is released into the wild in Africa. While these particular mosquitoes won’t have any mutations related to malaria transmission, researchers are hoping their release, and the work that led up to it, will help improve the perception of the research and trust in the science among regulators and locals alike. It will also inform future releases.

Teams in three African countries — Burkina Faso, Mali, and Uganda — are building the groundwork to eventually let loose “gene drive” mosquitoes, which would contain a mutation that would significantly and quickly reduce the mosquito population. Genetically engineered mosquitoes have already been released in places like Brazil and the Cayman Islands, though animals with gene drives have never been released in the wild.

The info is here.

Philosophy of Multicultures

Owen Flanagan
Philosophers Magazine
Originally published August 19, 2018

Here is an excerpt:

First, as I have been insisting, we live increasingly in multicultural, multiethnic, cosmopolitan worlds. Depending on one’s perspective these worlds are grand experiments in tolerant living, worlds in which prejudices break down; or they are fractured, wary, tense ethnic and religious cohousing projects; or they are melting pots where differences are thinned out and homogenised over time; or they are admixtures or collages of the best values, norms, and practices, the sociomoral equivalent of fine fusion cuisine or excellent world music that creates flavours or sounds from multiple fine sources; or on the other side, a blend of the worst of incommensurable value systems and practices, clunky and degenerate. It is good for ethicists to know more about people who are not from the North Atlantic (or its outposts). Or even if they are from the North Atlantic are not from elites or are not from “around here”. It matters how members of original displaced communities or people who were brought here or came here as chattel slaves or indentured workers or political refugees or for economic opportunity, have thought about virtues, values, moral psychology, normative ethics, and good human lives.

Second, most work in empirical moral psychology has been done on WEIRD people (Western Educated Industrialised Rich Democratic) and there is every reason to think WEIRD people are unrepresentative, possibly the most unrepresentative group imaginable, less representative than our ancestors when the ice melted at the end of the Pleistocene. It may be the assumptions we make about the nature of persons and the human good in the footnotes to Plato lineage and which seem secure are in fact parochial and worth re-examining.

Third, the methods of genetics, empirical psychology, evolutionary psychology, and neuroscience get lots of attention recently in moral psychology, as if they can ground an entirely secular and neutral form of common life. But it would be a mistake to think that these sciences are superior to the wisdom of the ages in gaining deep knowledge about human nature and the human good or that they are robust enough to provide a picture of a good life.

The info is here.

Monday, October 1, 2018

Moral Injury in International Relations

Jelena Subotic & Brent J Steele
Journal of Global Security Studies
https://doi.org/10.1093/jogss/ogy021
Published: 28 August 2018

Abstract

The war in Iraq unleashed disastrous global instability—from the strengthening of Al-Qaeda, to the creation of ISIS, and civil war in Syria accompanied by a massive exodus of refugees. The war in Afghanistan is continuing in perpetuity, with no clear goals or objectives other than the United States’ commitment to its sunk cost. The so-called war on terror is a vague catch-all phrase for a military campaign against moving targets and goalposts, with no end date and no conceivable way to declare victory. The toll of these wars on civilians in Iraq and Afghanistan and elsewhere in the Middle East, on US troops, and on the US economy is staggering. But these ambiguous campaigns are also fundamentally changing US state identity—its view of itself, its role in the world, and its commitment to a liberal international order. They are producing profound anxiety in the US body politic and anxiety in US relationships with other international actors. To understand the sources and consequences of this anxiety, we adopt an ontological security perspective on state identity. We enrich ontological security scholarship by introducing the concept of moral injury and its three main consequences: loss of control, ethical anxiety, and relational harm. We demonstrate how the concept of moral injury illuminates some of the most central anxieties at the core of US identity, offering a new understanding of our global moment of crisis.

The info is here.

How Do Medicalization and Rescue Fantasy Prevent Healthy Dying?

Peter T. Hetzler III and Lydia S. Dugdale
AMA Journal of Ethics
2018;20(8):E766-773.

Abstract

Before antibiotics, cardiopulmonary resuscitation (CPR), and life-sustaining technologies, humans had little choice about the timing and manner of their deaths. Today, the medicalization of death has enabled patients to delay death, prolonging their living and dying. New technology, the influence of the media, and medical professionals themselves have together transformed dying from a natural part of the human experience into a medical crisis from which a patient must be rescued, often through the aggressive extension of life or through its premature termination. In this paper, we examine problematic forms of rescue medicine and suggest the need to rethink medicalized dying within the context of medicine’s orientation to health and wholeness.

The info is here.

Sunday, September 30, 2018

Why It’s So Hard to Be an ‘Ethical’ Investor

Jon Sindreu and Sarah Kent
The Wall Street Journal
Originally posted September 1, 2018

In life, ethics are in the eye of the beholder. In investing, ethics are up to the whims of your fund manager.

With little regulation governing what a fund manager can call a “socially responsible” or “ethical” investment, a myriad of bespoke standards have popped up. Increasingly, these fund strategies are designed to beat the market rather than uphold morality.

This has created a dizzying of array possibilities when it comes to what these funds might hold. Fund companies can craft their definitions in such a way that they can simply rename existing products with an ethical allusion, without having to change their fund holdings.

Fund managers have rebranded at least two dozen existing mutual funds over the past few years, adding terms such as “sustainable,” and “ESG”—which stands for environmental, social and corporate governance, an industry buzzword.

The info is here.

Saturday, September 29, 2018

Want to live longer? Consider the ethics

John K. Davis
TheConversation.com
Originally published

Here is an excerpt:

Many people, such as philosopher John Harris and those in the Pew Center survey, worry that life extension would be available only to the rich and make existing inequalities even worse.

Indeed, it is unjust when some people live longer than the poor because they have better health care. It would be far more unjust if the rich could live several decades or centuries longer than anyone else and gain more time to consolidate their advantages.

Some philosophers suggest that society should prevent inequality by banning life extension. This is equality by denial – if not everyone can get it, then no one gets it.

However, as philosopher Richard J. Arneson notes, “leveling-down” – achieving equality by making some people worse off without making anyone better off – is unjust.

Indeed, as I argue in my recent book on life extension ethics, most of us reject leveling-down in other situations. For example, there are not enough human organs for transplant, but no one thinks the answer is to ban organ transplants.

Moreover, banning or slowing down the development of life extension may simply delay a time when the technology gets cheap enough for everyone to have it. TV sets were once a toy for the wealthy; now even poor families have them. In time, this could happen with life extension.

The info is here.

Friday, September 28, 2018

Nike, Kaepernick and the morality of capitalism

Steve Chapman
The Chicago Tribune
Originally posted September 5, 2018

Here is an excerpt:

The Republican Party has a large complement of corporate titans in its camp. But conservatives are reminded every day that some of the most successful and innovative companies are led and staffed by people whose worldview is deeply at odds with conservative ideology.

There is Amazon, whose founder and CEO, Jeff Bezos, owns The Washington Post, a frequent target of Trump’s animosity. There is Apple, where CEO Tim Cook has been a vocal critic of racial injustice and anti-gay discrimination. Facebook executive Sheryl Sandberg has written, “A truly equal world would be one where women ran half our countries and companies and men ran half our homes.”

Starbucks responded to Trump’s travel ban by pledging to hire 10,000 refugees. After the Parkland school massacre, Dick’s Sporting Goods stopped selling military-style firearms. Google, under pressure from employees opposed to creating “warfare technology,” withdrew from a Pentagon project on artificial intelligence.

But at the moment, the most visible face of corporate liberalism is Nike, whose new ad campaign features Kaepernick, a former San Francisco 49ers quarterback known for kneeling during the pregame national anthem to protest police abuses and racism. The campaign decision provoked a tweet from the president, who asserted, “Nike is getting absolutely killed with anger and boycotts.”

The info is here.

A Debate Over ‘Rational Suicide’

Paula Span
The New York Times
Originally posted August 31, 2018

Here is an excerpt:

Is suicide by older adults ever a rational choice? It’s a topic many older people discuss among themselves, quietly or loudly — and one that physicians increasingly encounter, too. Yet most have scant training or experience in how to respond, said Dr. Meera Balasubramaniam, a geriatric psychiatrist at the New York University School of Medicine.

“I found myself coming across individuals who were very old, doing well, and shared that they wanted to end their lives at some point,” said Dr. Balasubramaniam. “So many of our patients are confronting this in their heads.”

She has not taken a position on whether suicide can be rational — her views are “evolving,” she said. But hoping to generate more medical discussion, she and a co-editor explored the issue in a 2017 anthology, “Rational Suicide in the Elderly,” and she revisited it recently in an article in the Journal of the American Geriatrics Society.

The Hastings Center, the ethics institute in Garrison, N.Y., also devoted much of its latest Hastings Center Report to a debate over “voluntary death” to forestall dementia.

Every part of this idea, including the very phrase “rational suicide,” remains intensely controversial. (Let’s leave aside the related but separate issue of physician aid in dying, currently legal in seven states and the District of Columbia, which applies only to mentally competent people likely to die of a terminal illness within six months.)

The info is here.

Thursday, September 27, 2018

UNC protests present debate of law versus morality

Ali Akhyari
Charleston City Paper
Originally posted September 5, 2018

Here is an excerpt:

Immediately afterwards, UNC Chancellor Carol Folt referenced a 2015 law that protects historical monuments from being removed from any public property. Instead of making a public statement about the gross persistence of monuments to hate, she claimed her hands were tied and that students shouldn't break the law. Remember, after Charlottesville, it was president Trump who seemed incapable of acknowledging hate, saying there were "very fine people on both sides" after a woman was killed protesting the white supremacist march.

The debate regarding Confederate monuments and flags will never end so long as there are southerners more interested in rewriting history than admitting the Confederacy is intimately related to white supremacy. The true danger, though, is the normalization of white supremacy and nationalism in the Trump era. So it should follow, then, that Americans toppling monuments to oppression and hate will be increasingly forgivable as long as the the state and federal government coddles white nationalism.

Right after UNC, Trump tweeted a popular white nationalist talking point about land redistribution in post-Apartheid South Africa — a mirror of the battle minorities in this country have fought since emancipation.

So, I applaud the removal of Silent Sam. The monument fell at a time when the president has not only failed to recognize racism and historical oppression, instead encouraging it, pining for the return of Anglo-Saxon supremacy.

The info is here.

Superstition predicts perception of illusory control

Oren Griffiths, Noor Shehabi  Robin A. Murphy  Mike E. Le Pelley
British Journal of Psychology
First published August 24, 2018

Abstract

Superstitions are common, yet we have little understanding of the cognitive mechanisms that bring them about. This study used a laboratory‐based analogue for superstitious beliefs that involved people monitoring the relationship between undertaking an action (pressing a button) and an outcome occurring (a light illuminating). The task was arranged such that there was no objective contingency between pressing the button and the light illuminating – the light was just as likely to illuminate whether the button was pressed or not. Nevertheless, most people rated the causal relationship between the button press and the light illuminating to be moderately positive, demonstrating an illusion of causality. This study found that the magnitude of this illusion was predicted by people's level of endorsement of common superstitious beliefs (measured using a novel Superstitious Beliefs Questionnaire), but was not associated with mood variables or their self‐rated locus of control. This observation is consistent with a more general individual difference or bias to overweight conjunctive events over disjunctive events during causal reasoning in those with a propensity for superstitious beliefs.

The research is here.

Wednesday, September 26, 2018

Do psychotropic drugs enhance, or diminish, human agency?

Rami Gabriel
aeon.co
Originally posted September 3, 2018

Here is an excerpt:

Psychological medications such as Xanax, Ritalin and aspirin help to modify undesirable behaviours, thought patterns and the perception of pain. They purport to treat the underlying chemical cause rather than the social, interpersonal or psychodynamic causes of pathology. Self-knowledge gained by introspection and dialogue are no longer our primary means for modifying psychological states. By prescribing such medication, physicians are implicitly admitting that cognitive and behavioural training is insufficient and impractical, and that ‘the brain’, of which nonspecialists have little explicit understanding, is in fact the level where errors occur. Indeed, drugs are reliable and effective because they implement the findings of neuroscience and supplement (or in many cases substitute for) our humanist discourse about self-development and agency. In using such drugs, we become transhuman hybrid beings who build tools into the regulatory plant of the body.

Recreational drugs, on the other hand, are essentially hedonic tools that allow for stress-release and the diminishment of inhibition and sense of responsibility. Avenues of escape are reached through derangement of thought and perception; many find pleasure in this transcendence of quotidian experience and transgression of social norms. There is also a Dionysian, or spiritual, purpose to recreational inebriation, which can enable revelations that enhance intimacy and the emotional need for existential reflection. Here drugs act as portals into spiritual rituals and otherwise restricted metaphysical spaces. The practice of imbibing a sacred substance is as old as ascetic and mindfulness practices but, in our times, drugs are overwhelmingly the most commonly used tool for tending to this element of the human condition.

The info is here.

Navigating the Ethical Boundaries of Grateful Patient Fundraising

Collins ME, Rum SA, Sugarman J.
JAMA. Published online August 27, 2018.
doi:10.1001/jama.2018.11655

Here are two excerpts:

There is limited literature examining the ethical issues that grateful patient fundraising raises for physicians. The last American Medical Association report on this topic was issued in 2004.4 The report recognized the value of philanthropy and physicians’ role in it, but rightly emphasized the paramount importance of patients’ rights and welfare in efforts directed at grateful patient fundraising. As such, the report highlighted the need to ensure that gifts are voluntary, that patients should not perceive an obligation to give, and the need to protect privacy. In addition, the report cautioned against physicians initiating discussions about philanthropy during direct patient care. Furthermore, there is also limited literature about the ethical issues grateful patient fundraising poses for development professionals and the health care institutions they represent. Grappling with the ethical issues in grateful patient fundraising necessitates considering them from all of these perspectives.

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Among the key issues were challenges related to clinicians having discussions about philanthropy with patients who might be especially vulnerable due to their diseases or conditions, the tensions related to conflicts in regard to clinicians’ primary obligations to patient care and a competing obligation to fundraising, the potential effects of fundraising on patient care, possible unintended consequences of concierge services provided to donors, and concerns about privacy.5 The recommendations for clinicians include those concerning when grateful patient fundraising is appropriate (eg, ideally separate from the clinical encounter, not in situations of heightened vulnerability), minimizing conflicts of obligation and commitment, and respecting the donor’s intent of a gift. The recommendations for fundraising professionals and institutions include the need for transparency in relationships, not interfering with clinical care, attending to confidentiality and privacy, appropriateness of concierge services, and institutional policies and training in grateful patient fundraising.

The info is here.

Tuesday, September 25, 2018

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

Horrific deaths, brutal treatment: Mental illness in America’s jails

Gary A. Harki
The Virginian-Pilot
Originally published August 23, 2018

Here is an excerpt:

“We are arresting people who have no idea what the laws are or the rules are because they're off their medications,” said Nashville Sheriff Daron Hall, a vice president of the National Sheriffs’ Association. “You'd never arrest someone for a heart attack, but you're comfortable arresting someone who is diagnosed mentally ill. No other country in the world is doing it this way.”

In addition to causing pain and suffering for people with mental illness, the practice is costing municipalities millions.

At least 53 percent of the deaths examined have resulted in a lawsuit. Combined, the cases have cost municipalities at least $145 million. The true cost is much higher – in many cases, lawsuits are still pending and in others the settlement amount is secret. The figures also do not take into account lawyers’ fees.

The article is here.

There are a series of articles related to mental health issues in prison.

Monday, September 24, 2018

How to find the right therapist

Nicole Spector
www.nbcnews.com
Originally posted August 5, 2018

Here are two excerpts:

What does therapy mean to you? What areas of your life do you want to explore and how? Do you want to talk about your family, or would you rather focus on a very specific past trauma or would you just like someone to talk with about whatever might be troubling you that week? The answers to these questions may change over time, but when you first go into therapy, ideally you should have some picture of what you want.

“You should know what you want to work on [when beginning therapy],” says Dr. Cira. “Do you feel really strong that you don't want to focus on your past and only the present? Do you want to focus more on things that have happened to you in the past? Do you want someone to help you ‘solve’ your problems or someone who will really sit with you in your pain or both? These are all things you should ask yourself that will help guide your search.”

(cut)

“Listen to your intuition,” says Humphreys. “If you feel instinctively unsafe with a therapist, that will probably inhibit the progress you will make. In contrast, if you feel you ‘click’ with a therapist, that's a good sign that you will be able to build a working alliance with them.”

Jor-El Caraballo, a licensed therapist, wellness coach and co-creator of Viva Wellness, notes that while there are measures that are clinical in nature there is also “a visceral feeling of just being comfortable enough to sit in a room with someone for the therapy hour. That can't be replaced and if you don't feel comfortable enough in a few sessions then it's probably best to tell your therapist this and work toward moving on.”

The info is here.

Distinct Brain Areas involved in Anger versus Punishment during Social Interactions

Olga M. Klimecki, David Sander & Patrik Vuilleumier
Scientific Reports volume 8, Article number: 10556 (2018)

Abstract

Although anger and aggression can have wide-ranging consequences for social interactions, there is sparse knowledge as to which brain activations underlie the feelings of anger and the regulation of related punishment behaviors. To address these issues, we studied brain activity while participants played an economic interaction paradigm called Inequality Game (IG). The current study confirms that the IG elicits anger through the competitive behavior of an unfair (versus fair) other and promotes punishment behavior. Critically, when participants see the face of the unfair other, self-reported anger is parametrically related to activations in temporal areas and amygdala – regions typically associated with mentalizing and emotion processing, respectively. During anger provocation, activations in the dorsolateral prefrontal cortex, an area important for regulating emotions, predicted the inhibition of later punishment behavior. When participants subsequently engaged in behavioral decisions for the unfair versus fair other, increased activations were observed in regions involved in behavioral adjustment and social cognition, comprising posterior cingulate cortex, temporal cortex, and precuneus. These data point to a distinction of brain activations related to angry feelings and the control of subsequent behavioral choices. Furthermore, they show a contribution of prefrontal control mechanisms during anger provocation to the inhibition of later punishment.

The research is here.

Sunday, September 23, 2018

The radical moral implications of luck in human life

David Roberts
vox.com
Originally posted August 21, 2018

Here is an excerpt:

So, then, here you are. You turn 18. You are no longer a child; you are an adult, a moral agent, responsible for who you are and what you do.

By that time, your inheritance is enormous. You’ve not only been granted a genetic makeup, an ethnicity and appearance, by accidents of nature and parentage. You’ve also had your latent genetic traits “activated” in a very specific way through a specific upbringing, in a specific environment, with a specific set of experiences.

Your basic mental and emotional wiring is in place; you have certain instincts, predilections, fears, and cravings. You have a certain amount of money, certain social connections and opportunities, a certain family lineage. You’ve had a certain amount and quality of education. You’re a certain kind of person.

You are not responsible for any of that stuff; you weren’t yet capable of being responsible. You were just a kid (or worse, a teen). You didn’t choose your genes or your experiences. Both nature and the vast bulk of the nurture that matters happened to you.

And yet when you turn 18, it’s all yours — the whole inheritance, warts and all. By the time you are an autonomous, responsible moral agent, you have effectively been fired out of a cannon, on a particular trajectory. You wake up, morally speaking, midflight.

The info is here.

Saturday, September 22, 2018

The Business Case for Curiosity

Francesca Gino
Harvard Business Review
Originally posted September-October Issue

Here are two excerpts:

The Benefits of Curiosity

New research reveals a wide range of benefits for organizations, leaders, and employees.

Fewer decision-making errors.

In my research I found that when our curiosity is triggered, we are less likely to fall prey to confirmation bias (looking for information that supports our beliefs rather than for evidence suggesting we are wrong) and to stereotyping people (making broad judgments, such as that women or minorities don’t make good leaders). Curiosity has these positive effects because it leads us to generate alternatives.

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It’s natural to concentrate on results, especially in the face of tough challenges. But focusing on learning is generally more beneficial to us and our organizations, as some landmark studies show. For example, when U.S. Air Force personnel were given a demanding goal for the number of planes to be landed in a set time frame, their performance decreased. Similarly, in a study led by Southern Methodist University’s Don VandeWalle, sales professionals who were naturally focused on performance goals, such as meeting their targets and being seen by colleagues as good at their jobs, did worse during a promotion of a product (a piece of medical equipment priced at about $5,400) than reps who were naturally focused on learning goals, such as exploring how to be a better salesperson. That cost them, because the company awarded a bonus of $300 for each unit sold.

A body of research demonstrates that framing work around learning goals (developing competence, acquiring skills, mastering new situations, and so on) rather than performance goals (hitting targets, proving our competence, impressing others) boosts motivation. And when motivated by learning goals, we acquire more-diverse skills, do better at work, get higher grades in college, do better on problem-solving tasks, and receive higher ratings after training. Unfortunately, organizations often prioritize performance goals.

The information is here.

Friday, September 21, 2018

Surprised By A Medical Bill? Join The Club. Most Americans Say They Have Been

Alison Kodjak
www.npr.org
Originally posted September 2, 2018

Here is an excerpt:

Most survey respondents — 57 percent — have been surprised by a medical bill they thought would be paid for by their insurance companies, the survey from the research group NORC at the University of Chicago finds.

"People get surprised by all kinds of bills, for all kinds of reasons," says Caroline Pearson, a senior fellow at NORC.

Pearson herself says she was not expecting the problem to be so widespread.

The survey shows that 53 percent of those surveyed were surprised by a bill for a physician's service, and 51 percent got an unexpected bill for a laboratory test – like the urine test featured in our earlier story.

Hospital and health care facility charges surprised 43 percent of respondents, and 35 percent reported getting unexpected bills for imaging services, like the CT scan featured by NPR.

The survey shows that while some of the unexpected bills come because doctors or hospitals where patients are treated don't participate in the patients' insurance networks, the majority come because patients expect their insurance to cover more than it actually does.

The info is here.

Why Social Science Needs Evolutionary Theory

Christine Legare
Nautilus.com
Originally posted June 15, 2018

Here is an excerpt:

Human cognition and behavior is the product of the interaction of genetic and cultural evolution. Gene-culture co-evolution has allowed us to adapt to highly diverse ecologies and to produce cultural adaptations and innovations. It has also produced extraordinary cultural diversity. In fact, cultural variability is one of our species’ most distinctive features. Humans display a wider repertoire of behaviors that vary more within and across groups than any other animal. Social learning enables cultural transmission, so the psychological mechanisms supporting it should be universal. These psychological mechanisms must also be highly responsive to diverse developmental contexts and cultural ecologies.

Take the conformity bias. It is a universal proclivity of all human psychology—even very young children imitate the behavior of others and conform to group norms. Yet beliefs about conformity vary substantially between populations. Adults in some populations are more likely to associate conformity with children’s intelligence, whereas others view creative non-conformity as linked with intelligence. Psychological adaptations for social learning, such as conformity bias, develop in complex and diverse cultural ecologies that work in tandem to shape the human mind and generate cultural variation.

The info is here.

Thursday, September 20, 2018

Man-made human 'minibrains' spark debate on ethics and morality

Carolyn Y. Johnson
www.iol.za
Originally posted September 3, 2018

Here is an excerpt:

Five years ago, an ethical debate about organoids seemed to many scientists to be premature. The organoids were exciting because they were similar to the developing brain, and yet they were incredibly rudimentary. They were constrained in how big they could get before cells in the core started dying, because they weren't suffused with blood vessels or supplied with nutrients and oxygen by a beating heart. They lacked key cell types.

Still, there was something different about brain organoids compared with routine biomedical research. Song recalled that one of the amazing but also unsettling things about the early organoids was that they weren't as targeted to develop into specific regions of the brain, so it was possible to accidentally get retinal cells.

"It's difficult to see the eye in a dish," Song said.

Now, researchers are succeeding at keeping organoids alive for longer periods of time. At a talk, Hyun recalled one researcher joking that the lab had sung "Happy Birthday" to an organoid when it was a year old. Some researchers are implanting organoids into rodent brains, where they can stay alive longer and grow more mature. Others are building multiple organoids representing different parts of the brain, such as the hippocampus, which is involved in memory, or the cerebral cortex - the seat of cognition - and fusing them together into larger "assembloids."

Even as scientists express scepticism that brain organoids will ever come close to sentience, they're the ones calling for a broad discussion, and perhaps more oversight. The questions range from the practical to the fantastical. Should researchers make sure that people who donate their cells for organoid research are informed that they could be used to make a tiny replica of parts of their brain? If organoids became sophisticated enough, should they be granted greater protections, like the rules that govern animal research? Without a consensus on what consciousness or pain would even look like in the brain, how will scientists know when they're nearing the limit?

The info is here.

John Rawls’ ‘A Theory of Justice’

Ben Davis
1000-Word Philosophy
Originally posted July 27, 2018

Here is an excerpt:

Reasonable people often disagree about how to live, but we need to structure society in a way that reasonable members of that society can accept. Citizens could try to collectively agree on basic rules. We needn’t decide every detail: we might only worry about rules concerning major political and social institutions, like the legal system and economy, which form the ‘basic structure’ of society.

A collective agreement on the basic structure of society is an attractive ideal. But some people are more powerful than others: some may be wealthier, or part of a social majority. If people can dominate negotiations because of qualities that are, as Rawls (72-75) puts it, morally arbitrary, that is wrong. People don’t earn these advantages: they get them by luck. For anyone to use these unearned advantages to their own benefit is unfair, and the source of many injustices.

This inspires Rawls’ central claim that we should conceive of justice ‘as fairness.’ To identify fairness, Rawls (120) develops two important concepts: the original position and the veil of ignorance:

The original position is a hypothetical situation: Rawls asks what social rules and institutions people would agree to, not in an actual discussion, but under fair conditions, where nobody knows whether they are advantaged by luck. Fairness is achieved through the veil of ignorance, an imagined device where the people choosing the basic structure of society (‘deliberators’) have morally arbitrary features hidden from them: since they have no knowledge of these features, any decision they make can’t be biased in their own favour.

The brief, excellent synopsis is here.

Wednesday, September 19, 2018

Why “happy” doctors die by suicide

Pamela Wible
www.idealmedicalcare.org
Originally posted on August 24, 2018

Here is an excerpt:

Doctor suicides on the registry were submitted to me during a six-year period (2012-2018) by families, friends, and colleagues who knew the deceased. After speaking to thousands of suicidal physicians since 2012 on my informal doctor suicide hotline and analyzing registry data, I discovered surprising themes—many unique to physicians.

Public perception maintains that doctors are successful, intelligent, wealthy, and immune from the problems of the masses. To patients, it is inconceivable that doctors would have the highest suicide rate of any profession (5).

Even more baffling, “happy” doctors are dying by suicide. Many doctors who kill themselves appear to be the most optimistic, upbeat, and confident people. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head.

Doctors are masters of disguise and compartmentalization.

Turns out some of the happiest people—especially those who spend their days making other people happy—may be masking their own despair.

The info is here.

Many Cultures, One Psychology?

Nicolas Geeraert
American Scientist
Originally published in the July-August issue

Here is an excerpt:

The Self

If you were asked to describe yourself, what would you say? Would you list your personal characteristics, such as being intelligent or funny, or would you use preferences, such as “I love pizza”? Or perhaps you would instead mention social relationships, such as “I am a parent”? Social psychologists have long maintained that people are much more likely to describe themselves and others in terms of stable personal characteristics than they are to describe themselves in terms of their preferences or relationships.

However, the way people describe themselves seems to be culturally bound. In a landmark 1991 paper, social psychologists Hazel R. Markus and Shinobu Kitayama put forward the idea that self-construal is culturally variant, noting that individuals in some cultures understand the self as independent, whereas those in other cultures perceive it as interdependent.

People with an independent self-construal view themselves as free, autonomous, and unique individuals, possessing stable boundaries and a set of fixed characteristics or attributes by which their actions are guided. Independent self-construal is more prevalent in Europe and North America. By contrast, people with an interdependent self-construal see themselves as more connected with others close to them, such as their family or community, and think of themselves as a part of different social relationships.

The information is here.

Tuesday, September 18, 2018

Changing the way we communicate about patients

Abraar Karan
BMJ Blog
Originally posted August 29, 2018

Here is an excerpt:

There are many changes that we can make to improve how we communicate about patients. One of the easiest and most critical transformations is how we write our medical notes. One of the best doctors I ever worked with did exactly this, and is famous at the Brigham (our hospital) for doing it. He systematically starts every single note with the person’s social history. Who is this patient? It is not just a lady with abdominal pain. It is a mother of three, a retired teacher, and an active cyclist. That is the first thing we read about her, and so when I enter her room, I can’t help but see her this way rather than as a case of appendicitis.

This matters because patients deserve to be treated as people—a statement that’s so obvious it shouldn’t need to be said, but which physician behaviour doesn’t always reflect. You wouldn’t expect to know the most sensitive and vulnerable aspects of someone before even knowing their most basic background, yet we do this in medicine all the time. This is also important because in many clinical presentations, it provides critical information that helps deduce how they got sick, and why they may get sick again in the same way if we don’t restructure something essential in their life. For instance, if I didn’t know that the 22 year old opioid addict had just been kicked out of his house and is on the street without transportation to get to his suboxone clinic, I will not have truly solved what brought him to the hospital in the first place.

The info is here.

The So-Called Right to Try Law Gives Patients False Hope

Claudia Wallis
Scientific American
Originally posted in the September 2018 issue

There's no question about it: the new law sounds just great. President Donald Trump, who knows a thing or two about marketing, gushed about its name when he signed the “Right to Try” bill into law on May 30. He was surrounded by patients with incurable diseases, including a second grader with Duchenne muscular dystrophy, who got up from his small wheelchair to hug the president. The law aims to give such patients easier access to experimental drugs by bypassing the Food and Drug Administration.

The crowd-pleasing name and concept are why 40 states had already passed similar laws, although they were largely symbolic until the federal government got onboard. The laws vary but generally say that dying patients may seek from drugmakers any medicine that has passed a phase I trial—a minimal test of safety. “We're going to be saving tremendous numbers of lives,” Trump said. “The current FDA approval process can take many, many years. For countless patients, time is not what they have.”

But the new law won't do what the president claims. Instead it gives false hope to the most vulnerable patients. “This is a right to ask, not a right to try,” says Alison Bateman-House, a medical ethicist at New York University and an expert on the compassionate use of experimental drugs.

The info is here.

Monday, September 17, 2018

Who Is Experiencing What Kind of Moral Distress?

Carina Fourie
AMA J Ethics. 2017;19(6):578-584.

Abstract

Moral distress, according to Andrew Jameton’s highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses. However, such a broadening of the concept does not mean that the kind of moral distress being experienced, or the role of the person experiencing it, is morally irrelevant. I argue that differentiating between categories of distress—e.g., constraint and uncertainty—and between groups of health professionals who might experience moral distress is potentially morally relevant and should influence the analysis, measurement, and amelioration of moral distress in the clinic.

The info is here.

How our lives end must no longer be a taboo subject

Kathryn Mannix
The Guardian
Originally published August 16, 2018

Here is an excerpt:

As we age and develop long-term health conditions, our chances of becoming suddenly ill rise; prospects for successful resuscitation fall; our youthful assumptions about length of life may be challenged; and our quality of life becomes increasingly more important to us than its length. The number of people over the age of 85 will double in the next 25 years, and dementia is already the biggest cause of death in this age group. What discussions do we need to have, and to repeat at sensible intervals, to ensure that our values and preferences are understood by the people who may be asked about them?

Our families need to know our answers to such questions as: how much treatment is too much or not enough? Do we see artificial hydration and nutrition as “treatment” or as basic care? Is life at any cost or quality of life more important to us? And what gives us quality of life? A 30-year-old attorney may not understand that being able to hear birdsong, or enjoy ice-cream, or follow the racing results, is more important to a family’s 85-year-old relative than being able to walk or shop. When we are approaching death, what important things should our carers know about us?

The info is here.