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

Thursday, July 18, 2019

The Theory That Justified Anti-Gay Crime

Caleb Crain
The New Yorker
Originally posted June 26, 2019

Here is an excerpt:

As preposterous as the idea of homosexual panic may sound today, for much of the twentieth century it was treated as something like common sense. “When a beast attacks, you are justified in killing him,” is the way one defense attorney phrased the principle behind it, in 1940. The press, too, sometimes discussed the idea approvingly. The New York Daily News described a 1944 murder of a gay man as an “honor slaying.” In 1952, homosexual panic was listed as a mental disorder in the first edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, and, as late as the nineteen-nineties, the notion was still so current in the popular mind that a Christopher Street shop selling gay-themed T-shirts was called, in what seems to have been ironic homage, Don’t Panic.

It turns out that the psychological concept has a less than illustrious origin. The term “homosexual panic,” Polchin reports, was coined by a psychiatrist named Edward Kempf, in a 1920 treatise titled “Psychopathology.” Polchin garbles a key quote from Kempf, printing “sexually attracted” where Kempf wrote “sexually attractive,” and I took a look at the relevant chapter to see if I could make sense of it. It’s understandable that Polchin got confused. Kempf’s text is neither lucid nor coherent.

Kempf theorized that homosexual panic emerged from “the pressure of uncontrollable perverse sexual cravings,” that is, from the frustration of homosexual urges that typically arose in same-sex environments, such as prison or the military. According to Kempf, symptoms of the panic included a fearfulness that could lead to catatonia, a “compulsion to seek or submit to assault,” and delusional perceptions of being poisoned or entranced. Indeed, the hallucinations and paranoid delusions that many of Kempf’s patients suffered from were quite serious. One patient imagined that broken pills were being surreptitiously put into his pudding; another went through spells of believing he was God.

The info is here.

Taking Ethics Seriously: Toward Comprehensive Education in Ethics and Human Rights for Psychologists

Duška Franeta
European Psychologist (2019), 24, pp. 125-135.

Education in ethics and professional regulation are not alternatives; education in ethics for psychologists should not be framed merely as instruction regarding current professional regulation, or “ethical training.” This would reduce ethics to essentially a legal perspective, diminish professional responsibility, debase professional ethics, and downplay its primary purpose – the continuous critical reflection of professional identity and professional role. This paper discusses the meaning and function of education in ethics for psychologists and articulates the reasons why comprehensive education in ethics for psychologists should not be substituted by instruction in professional codes. Likewise, human rights education for psychologists should not be downgraded to mere instruction in existing legal norms. Human rights discourse represents an important segment of the comprehensive education in ethics for psychologists. Education in ethics should expose and examine substantial ethical ideas that serve as the framework for the law of human rights as well as the interpretative, multifaceted, evolving, even manipulable character of the human rights narrative. The typically proclaimed duty of psychologists to protect and promote human rights requires a deepening and expounding of the human rights legal framework through elaborate scrutiny of its ethical meaning. The idea of affirming and restoring human dignity – the concept often designated as the legal and ethical basis, essence, and purpose of human rights – represents one approach to framing this duty by which the goals of psychology on the professional and ethical levels become unified.

The info is here.

Wednesday, July 17, 2019

Deep Ethics: The Long-Term Quest to Decide Right from Wrong

Simon Beard
www.bbc.com
Originally posted June 18, 2019

Here is an excerpt:

Our sense of right and wrong goes back a long way, so it can be helpful to distinguish between ethics and “morality”. Morality is an individual’s, largely intuitive and emotional, sense of how they should treat others. It has probably existed for hundreds of thousands of years, and maybe even in other species. Ethics, on the other hand, is a formalised set of principles that claim to represent the truth about how people should behave. For instance, while almost everyone has a strong moral sense that killing is wrong and that it simply “mustn’t be done”, ethicists have long sought to understand why killing is wrong and under what circumstances (war, capital punishment, euthanasia) it may still be permissible.

Put a small group of people together in relative isolation and this natural moral sense will usually be enough to allow them to get along. However, at some point in our history, human societies became so large and complex that new principles of organisation were needed. Originally these were likely simple buttresses to our pre-existing emotions and intuitions: invoking a supernatural parent might bring together multiple kinship groups or identifying a common enemy might keep young men from fighting each other.

However, such buttresses are inherently unstable and attempts to codify more enduring principles began shortly after our ancestors began to form stable states. From the earliest written accounts, we see appeals to what are recognisably ethical values and principles.

The information is here.

Responsibility for Killer Robots

Johannes Himmelreich
Ethic Theory Moral Prac (2019).
https://doi.org/10.1007/s10677-019-10007-9

Abstract

Future weapons will make life-or-death decisions without a human in the loop. When such weapons inflict unwarranted harm, no one appears to be responsible. There seems to be a responsibility gap. I first reconstruct the argument for such responsibility gaps to then argue that this argument is not sound. The argument assumes that commanders have no control over whether autonomous weapons inflict harm. I argue against this assumption. Although this investigation concerns a specific case of autonomous weapons systems, I take steps towards vindicating the more general idea that superiors can be morally responsible in virtue of being in command.

Tuesday, July 16, 2019

Experts Recommend SCOTUS Adopt Code of Ethics to Promote Accountability

Jerry Lambe
www.lawandcrime.com
Originally posted June 24, 2019


Here is an excerpt:

While the high court’s justices must already abide by an ethical code, many of the experts noted that the current code does not sufficiently address modern ethical standards.

“The impartiality of our judiciary should be beyond reproach, so having a basic ethics code for its members to follow is a natural outgrowth of that common value, one that should be no less rigorously applied to our nation’s highest court,” Roth testified.

He added that disclosures from the court are particularly opaque, especially when sought out by the general public.

“To the outside observer, the current protocol makes it seem as if the judiciary is hiding something. […] With members of the judiciary already filling out and filing their reports digitally, the public should obtain them the same way, without having my organization act as the middleman,” Roth said.

Frost told the subcommittee that holding a hearing on the topic was a good first step in the process.

“Part of what I care about is not just the reality of impartial and fair justice, but the public’s perception of the courts,” she said, adding, “There have been signals by the justices that the court is considering rethinking adopting a code of ethics.”

The info is here.

The possibility and risks of artificial general intelligence

Phil Torres
Bulletin of the Atomic Scientists 
Volume 75, 2019 - Issue 3: Special issue: The global competition for AI dominance

Abstract

This article offers a survey of why artificial general intelligence (AGI) could pose an unprecedented threat to human survival on Earth. If we fail to get the “control problem” right before the first AGI is created, the default outcome could be total human annihilation. It follows that since an AI arms race would almost certainly compromise safety precautions during the AGI research and development phase, an arms race could prove fatal not just to states but for the entire human species. In a phrase, an AI arms race would be profoundly foolish. It could compromise the entire future of humanity.

Here is part of the paper:

AGI arms races

An AGI arms race could be extremely dangerous, perhaps far more dangerous than any previous arms race, including the one that lasted from 1947 to 1991. The Cold War race was kept in check by the logic of mutually-assured destruction, whereby preemptive first strikes would be met with a retaliatory strike that would leave the first state as wounded as its rival. In an AGI arms race, however, if the AGI’s goal system is aligned with the interests of a particular state, the result could be a winner-take-all scenario.

The info is here.


Monday, July 15, 2019

How the concept of forgiveness is used to gaslight women

Sophie King
Medium.com
Originally posted June 13, 2019

I’m not against the concept of forgiveness, I’ve chosen to forgive people countless times. However, what I’m definitely against, is pressuring people to forgive and shaming them if they don’t. I’ve found there’s a lot of stigma attached to those who choose not to forgive, especially if you’re a woman.

Women that don’t forgive, are assumed to be “scorned”, “bitter and twisted”. The stereotypes that surround “unforgiving” women, are used to gaslight them.

When women express that they’re upset or angry (and justifiably so), as a result of being hurt, people dismiss them as “bitter” and the validity of their feelings and experiences are questioned.

She isn’t psychologically traumatised because she’s been wronged, she’s just a “scorned woman”, “got an axe to grind”, “holding a grudge” and “unable to move on”. The fault lies with her, not the perpetrator because she won’t “let it go” and “get over it”. She’s not the victim, she’s bringing it on herself by not forgiving. The blame is shifted from the wrongdoer to the victim.

The info is here.

Why parents are struggling to find mental health care for their children

Bernard Wolfson
Kaiser Health News/PBS.org
Originally posted May 7, 2019

Here is an excerpt:

Think about how perverse this is. Mental health professionals say that with children, early intervention is crucial to avoid more severe and costly problems later on. Yet even parents with good insurance struggle to find care for their children.

The U.S. faces a growing shortage of mental health professionals trained to work with young people — at a time when depression and anxiety are on the rise. Suicide was the No. 2 cause of death for children and young adults from age 10 to 24 in 2017, after accidents.

There is only one practicing child and adolescent psychiatrist in the U.S. for about every 1,800 children who need one, according to data from the American Academy of Child & Adolescent Psychiatry.

Not only is it hard to get appointments with psychiatrists and therapists, but the ones who are available often don’t accept insurance.

“This country currently lacks the capacity to provide the mental health support that young people need,” says Dr. Steven Adelsheim, director of the Stanford University psychiatry department’s Center for Youth Mental Health and Wellbeing.

The info is here.

Sunday, July 14, 2019

The Voluntariness of Voluntary Consent: Consent Searches and the Psychology of Compliance

Sommers, Roseanna and Bohns, Vanessa K.
Yale Law Journal, Vol. 128, No. 7, 2019. 
Available at SSRN: https://ssrn.com/abstract=3369844

Abstract

Consent-based searches are by far the most ubiquitous form of search undertaken by police. A key legal inquiry in these cases is whether consent was granted voluntarily. This Essay suggests that fact finders’ assessments of voluntariness are likely to be impaired by a systematic bias in social perception. Fact finders are likely to under appreciate the degree to which suspects feel pressure to comply with police officers’ requests to perform searches.

In two preregistered laboratory studies, we approached a total of 209 participants (“Experiencers”) with a highly intrusive request: to unlock their password-protected smartphones and hand them over to an experimenter to search through while they waited in another room. A separate 194 participants (“Forecasters”) were brought into the lab and asked whether a reasonable person would agree to the same request if hypothetically approached by the same researcher. Both groups then reported how free they felt, or would feel, to refuse the request.

Study 1 found that whereas most Forecasters believed a reasonable person would refuse the experimenter’s request, most Experiencers — 100 out of 103 people — promptly unlocked their phones and handed them over. Moreover, Experiencers reported feeling significantly less free to refuse than did Forecasters contemplating the same situation hypothetically.

Study 2 tested an intervention modeled after a commonly proposed reform of consent searches, in which the experimenter explicitly advises participants that they have the right to with- hold consent. We found that this advisory did not significantly reduce compliance rates or make Experiencers feel more free to say no. At the same time, the gap between Experiencers and Forecasters remained significant.

These findings suggest that decision makers judging the voluntariness of consent consistently underestimate the pressure to comply with intrusive requests. This is problematic because it indicates that a key justification for suspicionless consent searches — that they are voluntary — relies on an assessment that is subject to bias. The results thus provide support to critics who would like to see consent searches banned or curtailed, as they have been in several states.

The results also suggest that a popular reform proposal — requiring police to advise citizens of their right to refuse consent — may have little effect. This corroborates previous observational studies, which find negligible effects of Miranda warnings on confession rates among interrogees, and little change in rates of consent once police start notifying motorists of their right to refuse vehicle searches. We suggest that these warnings are ineffective because they fail to address the psychology of compliance. The reason people comply with police, we contend, is social, not informational. The social demands of police-citizen interactions persist even when people are informed of their rights. It is time to abandon the myth that notifying people of their rights makes them feel empowered to exercise those rights.

Saturday, July 13, 2019

The Worst Patients in the World

David Freedman
The Atlantic - July 2019 Issue

Here are two excerpts:

Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Surely, some might add, a program like Medicare for All would help by discouraging high-cost, ineffective treatments.

But lost in these discussions is, well, us. We ought to consider the possibility that if we exported Americans to those other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?

(cut)

American patients’ flagrant disregard for routine care is another problem. Take the failure to stick to prescribed drugs, one more bad behavior in which American patients lead the world. The estimated per capita cost of drug noncompliance is up to three times as high in the U.S. as in the European Union. And when Americans go to the doctor, they are more likely than people in other countries to head to expensive specialists. A British Medical Journal study found that U.S. patients end up with specialty referrals at more than twice the rate of U.K. patients. They also end up in the ER more often, at enormous cost. According to another study, this one of chronic migraine sufferers, 42 percent of U.S. respondents had visited an emergency department for their headaches, versus 14 percent of U.K. respondents.

Finally, the U.S. stands out as a place where death, even for the very aged, tends to be fought tooth and nail, and not cheaply. “In the U.K., Canada, and many other countries, death is seen as inevitable,” Somava Saha said. “In the U.S., death is seen as optional. When [people] become sick near the end of their lives, they have faith in what a heroic health-care system will accomplish for them.”

The info is here.

Friday, July 12, 2019

The Troubled History of Psychiatry

Jerome Groopman
The New Yorker
Originally posted May 20, 2019

Here is an excerpt:

Yet, despite the phenomenal success of Prozac, and of other SSRIs, no one has been able to produce definitive experimental proof establishing neurochemical imbalances as the pathogenesis of mental illness. Indeed, quite a lot of evidence calls the assumption into question. Clinical trials have stirred up intense controversy about whether antidepressants greatly outperform the placebo effect. And, while SSRIs do boost serotonin, it doesn’t appear that people with depression have unusually low serotonin levels. What’s more, advances in psychopharmacology have been incremental at best; Harrington quotes the eminent psychiatrist Steven Hyman’s assessment that “no new drug targets or therapeutic mechanisms of real significance have been developed for more than four decades.” This doesn’t mean that the available psychiatric medication isn’t beneficial. But some drugs seem to work well for some people and not others, and a patient who gets no benefit from one may do well on another. For a psychiatrist, writing a prescription remains as much an art as a science.

Harrington’s book closes on a sombre note. In America, the final decade of the twentieth century was declared the Decade of the Brain. But, in 2010, the director of the National Institute of Mental Health reflected that the initiative hadn’t produced any marked increase in rates of recovery from mental illness. Harrington calls for an end to triumphalist claims and urges a willingness to acknowledge what we don’t know.

Although psychiatry has yet to find the pathogenesis of most mental illness, it’s important to remember that medical treatment is often beneficial even when pathogenesis remains unknown. After all, what I was taught about peptic ulcers and stress wasn’t entirely useless; though we now know that stress doesn’t cause ulcers, it can exacerbate their symptoms. Even in instances where the discovery of pathogenesis has produced medical successes, it has often worked in tandem with other factors. Without the discovery of H.I.V. we would not have antiretroviral drugs, and yet the halt in the spread of the disease owes much to simple innovations, such as safe-sex education and the distribution of free needles and condoms.

The info is here.

Tribalism is Human Nature

Cory Clark, Brittany Liu, Bo Winegard, and Peter Ditto
Pre-print

Abstract

Humans evolved in the context of intense intergroup competition, and groups comprised of loyal members more often succeeded than those that were not. Therefore, selective pressures have consistently sculpted human minds to be "tribal," and group loyalty and concomitant cognitive biases likely exist in all groups. Modern politics is one of the most salient forms of modern coalitional conflict and elicits substantial cognitive biases. Given the common evolutionary history of liberals and conservatives, there is little reason to expect pro-tribe biases to be higher on one side of the political spectrum than the other. We call this the evolutionarily plausible null hypothesis and recent research has supported it. In a recent meta-analysis, liberals and conservatives showed similar levels of partisan bias, and a number of pro-tribe cognitive tendencies often ascribed to conservatives (e.g., intolerance toward dissimilar others) have been found in similar degrees in liberals. We conclude that tribal bias is a natural and nearly ineradicable feature of human cognition, and that no group—not even one’s own—is immune.

Here is part of the Conclusion:

Humans are tribal creatures. They were not designed to reason dispassionately about the world; rather, they were designed to reason in ways that promote the interests of their coalition (and hence, themselves). It would therefore be surprising if a particular group of individuals did not display such tendencies, and recent work suggests, at least in the U.S. political sphere, that both liberals and conservatives are substantially biased—and to similar degrees. Historically, and perhaps even in modern society, these tribal biases are quite useful for group cohesion but perhaps also for other moral purposes (e.g., liberal bias in favor of disadvantaged groups might help increase equality). Also, it is worth noting that a bias toward viewing one’s own tribe in a favorable light is not necessarily irrational. If one’s goal is to be admired among one’s own tribe, fervidly supporting their agenda and promoting their goals, even if that means having or promoting erroneous beliefs, is often a reasonable strategy (Kahan et al., 2017). The incentives for holding an accurate opinion about global climate change, for example, may not be worth the social rejection and loss of status that could accompany challenging the views of one’s political ingroup. However, these biases decrease the likelihood of consensus across political divides. Thus, developing effective strategies for disincentivizing political tribalism and promoting the much less natural but more salutary tendencies toward civil political discourse and reasonable compromise are crucial priorities for future research. A useful theoretical starting point is that tribalism and concomitant biases are part of human nature, and that no group, not even one’s own, is immune.

A pre-print is here.

Thursday, July 11, 2019

Civic honesty around the globe

Alain Cohn, Michel André Maréchal, David Tannenbaum, & Christian Lukas Zünd
Science  20 Jun 2019:
DOI: 10.1126/science.aau8712

Abstract

Civic honesty is essential to social capital and economic development, but is often in conflict with material self-interest. We examine the trade-off between honesty and self-interest using field experiments in 355 cities spanning 40 countries around the globe. We turned in over 17,000 lost wallets with varying amounts of money at public and private institutions, and measured whether recipients contacted the owner to return the wallets. In virtually all countries citizens were more likely to return wallets that contained more money. Both non-experts and professional economists were unable to predict this result. Additional data suggest our main findings can be explained by a combination of altruistic concerns and an aversion to viewing oneself as a thief, which increase with the material benefits of dishonesty.

Here is the conclusion:

Our findings also represent a unique data set for examining cross-country differences in civic honesty. Honesty is a key component of social capital, and here we provide an objective measure to supplement the large body of work that has traditionally examined social capital using subjective survey measures. Using average response rates across countries, we find substantial variation in rates of civic honesty, ranging from 14% to 76%. This variation largely persists even when controlling for a country’s gross domestic product, suggesting that other factors besides country wealth are also at play. In the supplementary materials, we provide an analysis suggesting that economically favorable geographic conditions, inclusive political institutions, national education, and cultural values that emphasize moral norms extending beyond one’s in-group are also positively associated with rates of civic honesty. Future research is needed to identify how these and other factors may contribute to societal differences in honest behavior.

The research is here.

The Business of Health Care Depends on Exploiting Doctors and Nurses

Danielle Ofri
The New York Times
Originally published June 8, 2019

One resource seems infinite and free: the professionalism of caregivers.

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently.  A colleague has a family emergency and the hospital needs you to work a double shift.  Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out.  You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses.  Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

It is true that health care has become corporatized to an almost unrecognizable degree.  But it is also true that most clinicians remain committed to the ethics that brought them into the field in the first place.  This makes the hospital an inspiring place to work.

Increasingly, though, I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated.

By now, corporate medicine has milked just about all the “efficiency” it can out of the system.  With mergers and streamlining, it has pushed the productivity numbers about as far as they can go.

But one resource that seems endless — and free — is the professional ethic of medical staff members.

This ethic holds the entire enterprise together.  If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous.  Doctors and nurses know this, which is why they don’t shirk.  The system knows it, too, and takes advantage.

The demands on medical professionals have escalated relentlessly in the past few decades, without a commensurate expansion of time and resources.  For starters, patients are sicker these days.  The medical complexity per patient — the number and severity of chronic conditions — has steadily increased, meaning that medical encounters are becoming ever more involved.  They typically include more illnesses to treat, more medications to administer, more complications to handle — all in the same-length office or hospital visit.

The information is here.

Wednesday, July 10, 2019

Fostering an Ethical Culture on Your Sales Team

Kristen Bell DeTienne, Bradley R. Agle, and others
Harvard Business Review
Originally posted June 20, 2019

Here is an excerpt:

Create a Culture of Ethical Values. 

Employees can suffer several negative consequences if they are told to do things that conflict with their ethical values. Meanwhile, companies can suffer negative consequences from employees not living up to the organization’s values. Managers can help by involving sales associates in conversations about personal and organizational values and by helping employees reconcile discrepancies and honor both their personal and organizational values.

During one of our ethics training sessions with a U.S.-based corporation, employees first described their own values and the company’s values. In teams, they set goals for sales achievement, then wrote a code of conduct that would promote that achievement while still respecting both individual and company values. One associate’s value was “not to push the clients too much when they need time to decide.” This seemed at odds with the company’s values to “finalize the sale” and “never abandon an opportunity.” So, the employees created a rule that honored both values: “Give your customers the time they need to think about your offer, but immediately fix the next appointment.” This hybrid rule brought peace of mind to employees—and a better sales experience to their customers.

The info is here.

Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years

Aliya Alimujiang, Ashley Wiensch, Jonathan Boss, and others
JAMA Network Open 2019;2(5):e194270. 

Abstract

Importance  A growing body of literature suggests that having a strong sense of purpose in life leads to improvements in both physical and mental health and enhances overall quality of life. There are interventions available to influence life purpose; thus, understanding the association of life purpose with mortality is critical.

Objective  To evaluate whether an association exists between life purpose and all-cause or cause-specific mortality among older adults in the United States.

Main Outcomes and Measures  All-cause and cause-specific mortality were assessed between 2006 and 2010. Weighted Cox proportional hazards models were used to evaluate life purpose and mortality.

Results  Of 6985 individuals included in the analysis, 4016 (57.5%) were women, the mean (SD) age of all participants was 68.6 (9.8) years, and the mean (SD) survival time for decedents was 31.21 (15.42) months (range, 1.00-71.00 months). Life purpose was significantly associated with all-cause mortality in the HRS (hazard ratio, 2.43; 95% CI, 1.57-3.75, comparing those in the lowest life purpose category with those in the highest life purpose category). Some significant cause-specific mortality associations with life purpose were also observed (heart, circulatory, and blood conditions: hazard ratio, 2.66; 95% CI, 1.62-4.38).

Conclusions and Relevance  This study’s results indicated that stronger purpose in life was associated with decreased mortality. Purposeful living may have health benefits. Future research should focus on evaluating the association of life purpose interventions with health outcomes, including mortality. In addition, understanding potential biological mechanisms through which life purpose may influence health outcomes would be valuable.

The research is here.


Tuesday, July 9, 2019

Does psychology have a conflict-of-interest problem?

Tom Chivers
Nature
Originally published July 2, 2019

Here is an excerpt:

But other psychologists say they think personal speaking fees ought to be declared. There is no suggestion that any scientists are deliberately skewing their results to maintain their speaking income. But critics say that lax COI disclosure norms could create problems by encouraging some scientists to play down — perhaps unconsciously — findings that contradict their arguments, and could lead them to avoid declaring other conflicts. “A lot of researchers don’t know where to draw the line [on COIs],” says Chris Chambers, a psychologist at the University of Cardiff, UK, who is an editor for five journals, including one on psychology. “And because there are no norms they gravitate to saying nothing.”

Researchers who spoke to Nature about their concerns say they see the issue as connected to psychology’s greater need for self-scrutiny because of some high-profile cases of misconduct, as well as to broader concerns about the reproducibility of results. “Even the appearance of an undisclosed conflict of interest can be damaging to the credibility of psychological science,” says Scott Lilienfeld, the editor-in-chief of Clinical Psychological Science (CPS), which published papers of Twenge’s in 2017 and 2018. “The heuristic should be ‘when in doubt, declare’,” he says (although he added that he did not have enough information to judge Twenge’s non-disclosures in CPS). Psychology, he adds, needs to engage in a “thoroughgoing discussion of what constitutes a conflict of interest, and when and how such conflicts should be disclosed”.

The info is here.

A Waste of 1,000 Research Papers

Ed Yong
The Atlantic
Originally posted May 17, 2019

In 1996, a group of European researchers found that a certain gene, called SLC6A4, might influence a person’s risk of depression.

It was a blockbuster discovery at the time. The team found that a less active version of the gene was more common among 454 people who had mood disorders than in 570 who did not. In theory, anyone who had this particular gene variant could be at higher risk for depression, and that finding, they said, might help in diagnosing such disorders, assessing suicidal behavior, or even predicting a person’s response to antidepressants.

Back then, tools for sequencing DNA weren’t as cheap or powerful as they are today. When researchers wanted to work out which genes might affect a disease or trait, they made educated guesses, and picked likely “candidate genes.” For depression, SLC6A4 seemed like a great candidate: It’s responsible for getting a chemical called serotonin into brain cells, and serotonin had already been linked to mood and depression. Over two decades, this one gene inspired at least 450 research papers.

But a new study—the biggest and most comprehensive of its kind yet—shows that this seemingly sturdy mountain of research is actually a house of cards, built on nonexistent foundations.

Richard Border of the University of Colorado at Boulder and his colleagues picked the 18 candidate genes that have been most commonly linked to depression—SLC6A4 chief among them. Using data from large groups of volunteers, ranging from 62,000 to 443,000 people, the team checked whether any versions of these genes were more common among people with depression. “We didn’t find a smidge of evidence,” says Matthew Keller, who led the project.

The info is here.

Monday, July 8, 2019

Making Policy on Augmented Intelligence in Health Care

Elliott Crigger and Christopher Khoury
AMA J Ethics. 2019;21(2):E188-191.
doi: 10.1001/amajethics.2019.188

Abstract

In June 2018, the American Medical Association adopted new policy to provide a broad framework for the evolution of artificial intelligence (AI) in health care that is designed to help ensure that AI realizes the benefits it promises for patients, physicians, and the health care community.

Here is the end of the article:

The AMA’s adoption of H-480.940 suggests the ethical importance of these questions in calling for development of thoughtfully designed, high-quality, clinically validated health care AI that does the following:

a) is designed and evaluated in keeping with best practices in user-centered design, particularly for physicians and other members of the health care team;
b) is transparent;
c) conforms to leading standards for reproducibility;
d) identifies and takes steps to address bias and avoids introducing or exacerbating health care disparities including when testing or deploying new AI tools on vulnerable populations; and
e) safeguards patients’ and other individuals’ privacy interests and preserves the security and integrity of personal information.

Values of ethical relevance considered in this policy include professionalism, transparency, justice, safety, and privacy.

The info is here.

Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation

Bradley Belsher, Derek Smolenski, Larry Pruitt, and others
JAMA Psychiatry. 2019;76(6):642-651.
doi:10.1001/jamapsychiatry.2019.0174

Abstract
Importance  Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente.

Objectives
To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates.

Evidence Review
A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies.

Findings
From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics.

Conclusions and Relevance
To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.

Sunday, July 7, 2019

Time to End Physician Sexual Abuse of Patients: Calling the U.S. Medical Community to Action

AbuDagga, A., Carome, M. & Wolfe, S.M.
J GEN INTERN MED (2019).
https://doi.org/10.1007/s11606-019-05014-6

Abstract

Despite the strict prohibition against all forms of sexual relations between physicians and their patients, some physicians cross this bright line and abuse their patients sexually. The true extent of sexual abuse of patients by physicians in the U.S. health care system is unknown. An analysis of National Practitioner Data Bank reports of adverse disciplinary actions taken by state medical boards, peer-review sanctions by institutions, and malpractice payments shows that a very small number of physicians have faced “reportable” consequences for this unethical behavior. However, physician self-reported data suggest that the problem occurs at a higher rate. We discuss the factors that can explain why such sexual abuse of patients is a persistent problem in the U.S. health care system. We implore the medical community to begin a candid discussion of this problem and call for an explicit zero-tolerance standard against sexual abuse of patients by physicians. This standard must be coupled with regulatory, institutional, and cultural changes to realize its promise. We propose initial recommendations toward that end.

Saturday, July 6, 2019

Congress weighs dropping ban on altering the DNA of human embryos used for pregnancies

Embryonic cell divisionSharon Begley and Andrew Joseph
www.statnews.xom
Originally posted June 4, 2019

A congressional committee is expected to vote on Tuesday to drop a ban on altering the genomes of human embryos intended for pregnancies, which could open the door to creating babies with genetic material from three people or with genomes that have been modified in a way that would be inherited by their descendants, as China’s “CRISPR babies” were.

The prohibition on modifying the DNA of embryos for reproduction (as opposed to doing so in basic research that stops short of pregnancies) has been attached to bills that fund the Food and Drug Administration since December 2015. But last month, a House appropriations subcommittee approved a version of an FDA spending bill without the amendment, or rider — amid worldwide condemnation of the CRISPR babies experiment last year and calls by leading scientists for a global moratorium on creating gene-edited babies.

“People don’t appreciate that this is the only piece of legislation in the United States that stands between us and genetically engineered children,” said science historian J. Benjamin Hurlbut of Arizona State University, who supports a “global observatory” to track uses of CRISPR, the powerful genome-editing technology.

The info is here.

Friday, July 5, 2019

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study

Yee, A., Zubovic, E, and others
Surgery May 2019Volume 165, Issue 5, Pages 860–867

Abstract

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.

The info is here.

Thursday, July 4, 2019

What a Pediatrician Saw Inside a Border Patrol Warehouse

Jeremy Raff
The Atlantic
Originally posted July 3, 2019

Here are two excerpts:

As agents brought in the children she requested, Sevier said, the smell of sweat and soiled clothing filled the room. They had not been allowed to bathe or change since crossing the Rio Grande and turning themselves over to officials. Sevier found that about two-thirds of the kids she examined had symptoms of respiratory infection. The guards wore surgical masks, but the detainees breathed the air unfiltered. As the children filed in, Sevier said she found evidence of sleep deprivation, dehydration, and malnutrition too.

(cut)

During the exam, she noticed that the toddler behaved differently from the kids his age she sees every day. In an exam room at her clinic decorated with a Lion King mural, I watched her do a routine checkup on a slightly younger boy. This toddler pulled back when Sevier touched him, but was easily soothed by his mother. The reaction was normal—“a small oscillation between worried and okay,” Sevier explained. A little shyness is typical, she said, but toddlers “shouldn't be fearful of a stranger.” When they are afraid—when the memory of their last shots is fresh in their mind, for instance—they resist Sevier by crying, clinging to their caregiver, or squirming beneath her stethoscope.

At Ursula, however, the children Sevier examined—like the panting 2-year-old—were “totally fearful, but then entirely subdued,” she told me. She could read the fear in their faces, but they were perfectly submissive to her authority. “I can only explain it by trauma, because that is such an unusual behavior,” she said. Sevier had brought along Mickey Mouse toys to break the ice, and the kids seem to enjoy playing with them. Yet none resisted, she said, when she took them away at the end of the exam. “At some point,” Sevier mused, “you’re broken and you stop fighting.”

The info is here.

Exposure to opposing views on social media can increase political polarization

Christopher Bail, Lisa Argyle, and others
PNAS September 11, 2018 115 (37) 9216-9221; first published August 28, 2018 https://doi.org/10.1073/pnas.1804840115

Abstract

There is mounting concern that social media sites contribute to political polarization by creating “echo chambers” that insulate people from opposing views about current events. We surveyed a large sample of Democrats and Republicans who visit Twitter at least three times each week about a range of social policy issues. One week later, we randomly assigned respondents to a treatment condition in which they were offered financial incentives to follow a Twitter bot for 1 month that exposed them to messages from those with opposing political ideologies (e.g., elected officials, opinion leaders, media organizations, and nonprofit groups). Respondents were resurveyed at the end of the month to measure the effect of this treatment, and at regular intervals throughout the study period to monitor treatment compliance. We find that Republicans who followed a liberal Twitter bot became substantially more conservative posttreatment. Democrats exhibited slight increases in liberal attitudes after following a conservative Twitter bot, although these effects are not statistically significant. Notwithstanding important limitations of our study, these findings have significant implications for the interdisciplinary literature on political polarization and the emerging field of computational social science.

The research is here.

Happy Fourth of July!!!

Wednesday, July 3, 2019

Rep. Matt Gaetz to be investigated by House Ethics for tweet apparently threatening Cohen

Emily Kopp
www.rollcall.com
Originally published June 28, 2019


Rep. Matt Gaetz faces an inquiry by the House Ethics Committee for a tweet that appeared to threaten President Donald Trump’s former lawyer Michael Cohen with blackmail.

The House Ethics Committee announced Friday it would establish an investigative subcommittee to review whether the Florida Republican, a staunch ally of the president, sought to intimidate Cohen before he testified before the House Oversight and Reform panel. The Ethics Committee had sought an interview with Gaetz, but he declined, triggering the investigation.

“If members of Congress want to spend their time psychoanalyzing my tweets, it’s certainly their prerogative,” Gaetz said in an emailed statement. “I won’t be joining them in the endeavor.”

Maryland Democrat Anthony G. Brown will serve as the chairman of the investigative subcommittee, while Mississippi RepublicanMichael Guest will be the ranking member. The panel will have the power to issue subpoenas in its pursuit of information, documents and interviews.

The info is here.

U.S. Suicide Rates Are the Highest They've Been Since World War II

Jamie Ducharme
Time.com
Originally posted June 20, 2019

U.S. suicide rates are at their highest since World War II, according to federal data—and the opioid crisis, widespread social media use and high rates of stress may be among the myriad contributing factors.

In 2017, 14 out of every 100,000 Americans died by suicide, according to a new analysis released by the Centers for Disease Control and Prevention’s National Center for Health Statistics. That’s a 33% increase since 1999, and the highest age-adjusted suicide rate recorded in the U.S. since 1942. (Rates were even higher during the Great Depression, hitting a century peak of 21.9 in 1932.)

“I don’t think there’s a one-size-fits all reason” since there’s almost never a single cause of suicide, says Jill Harkavy-Friedman, vice president of research at the American Foundation for Suicide Prevention, a nonprofit that supports suicide prevention research, education and policy. “I don’t think there’s something you can pinpoint, but I do think a period of increased stress and a lack of a sense of security may be contributing.”

It’s even more difficult to assign causes to the uptick, Harkavy-Friedman says, because it’s happening across diverse demographic groups. Men have historically died by suicide more frequently than women, and that’s still true: As of 2017, the male suicide rate was more than three times higher than the female rate. But female suicide rates are rising more quickly—by 53% since 1999, compared to 26% for men—and the gap is narrowing. For both genders, suicide rates are highest among American Indians and Alaska natives, compared to other ethnicities, and when the data are broken down by age group, the most suicide deaths are reported among people ages 45 to 64—but nearly every ethnic and age group saw an increase of some size from 1999 to 2017.

The info is here.

Tuesday, July 2, 2019

EPA’s top air policy official steps down amid scrutiny over possible ethics violations

The Washington Post
Originally published June 26, 2019

Here is an excerpt:

Less than one month after joining the EPA, Wehrum met with two former clients at his old firm without consulting in advance with ethics officials, even though they had cautioned him about such interactions. That same month, Wehrum participated in a decision that appeared to benefit a former client, DTE Energy, in which then-EPA Administrator Scott Pruitt issued a memo stating that the agency would not be “second guessing utilities” when they projected whether they would need a few federal permits after expanding their operations.

Wehrum, who heads the air and radiation office at the EPA, acknowledged both incidents in an interview with The Post but said he had determined that he did not violate federal ethics rules.

“I have, from day one, tried to be absolutely strict and assiduous as to what I do about complying with my ethical obligations,” Wehrum said, “because it doesn’t do me any good, and it doesn’t do the agency any good, to be doing things that people see as unethical.”

Still, the fallout from reporting on Wehrum’s ties to his former firm and the utility industry by The Post and other outlets — including Politico, the New York Times and E&E News — has continued to reverberate. The Utility Air Regulatory Group, a group of power companies that paid Hunton Andrews Kurth millions in membership dues, disbanded earlier this year.

Wehrum’s decision to leave is the second high-profile EPA resignation in the past year. Last July, Pruitt stepped down after facing probes by Congress, the EPA Office of Inspector General and the Office of Special Counsel for his management and spending practices.

The info is here.

Moral Decision Making, Religious Strain, and the Experience of Moral Injury

Steven Lancaster and Maggie Miller
PsyArXiv Preprints

Abstract

Moral injury is the recognition that acts perpetrated during combat, or other stressful situations, can having lasting psychological impacts. Models of moral injury examine the role of transgressive acts, moral appraisals of these acts, and the symptoms of moral injury. However, little research has examined potential pathways between these elements. The current study examined everyday moral decision making and aspects of religious functioning as possible mediators of these relationships in a military veteran sample. Our pre-registered structural equation model supported a relationship between acts and appraisals; however, this relationship was not mediated by moral decision making as we had hypothesized. Our results demonstrated that religious strain significantly mediated the relationship between moral appraisals and both self- and other-directed symptoms of moral injury. Additional research is needed to better understand how and which transgressive acts are appraised as morally wrong. Further research is also needed to better integrate moral decision making into our understanding of moral injury.

From the Discussion:

Contrary to our predictions, moral decision making did not mediate the relationship between acts and appraisals in our hypothesized model.  This is surprising due to moral conflict being seen as the core of moral injury experience (Jinkerson, 2016).  Given the importance of moral evaluations of one’s actions in moral injury, we expected that one’s “moral compass would make a significant contribution to this model (Drescher & Foy, 2008, p. 99).  It is not clear whether this null finding is due to the method in which moral decision making was assessed or if perhaps moral decision making for everyday experiences (or non-combat experiences) fails to play a role in how one evaluates their potentially transgressive experiences (Christensen & Gomila, 2012).  The EDMD is limited in at least two ways which may have affected our results.  First, the test lacks a contemplation component which is necessary for the psychological processing of an moral decision (Gunia, Wang, Huang, Wang, & Murnighan, 2012).  Second, given that the EDMD focuses on everyday experiences, it may be limited in its ability to assess the moral decisions made during stressful situations (Yousef et al., 2012).  While moral decision making did not mediate as the act-appraisal relationship as hypothesized, it was correlated with other-directed symptoms of moral injury and the MODINDICES output in MPLUS indicated this pathway would improve model fit.  While not hypothesized, one reason for this finding could be that higher altruism leads an individual to give the “benefit of the doubt” to others, particularly those with whom they have endured stressful or traumatic experiences (Staub & Vollhardt, 2008).  Given the relatively young status of the field, additional research is needed to better understand who experiences these acts as negative/wrong and for which types of events does this occur.  Future studies may want to incorporate a broad range of potential mediators including multiple indices of moral decision making.

The pre-print is here.

Monday, July 1, 2019

House Panel Subpoenas Kellyanne Conway over ‘Egregious’ Ethics Violations

Jack Crowe
The National Review
Originally posted June 26, 2019


Here is an excerpt:

Henry J. Kerner, the special counsel, whose role is unrelated to Robert Mueller’s investigation, argued in his Wednesday testimony that Conway’s repeated violations of the Hatch Act — which stem from her endorsement of Republican congressional candidates during television interviews and on Twitter — created an “unprecedented challenge” to his office’s ability to enforce federal law.

Conway has dismissed the accusations of ethics violations as an unprecedented and politically motivated attack on the administration.

“If you’re trying to silence me through the Hatch Act, it’s not going to work,” Conway said when asked about her alleged violations during a May interview, adding “let me know when the jail sentence starts.”

Kerner, in his letter to the president and in his testimony, argued that Conway’s refusal to accept responsibility created a dangerous precedent and was further reason to dismiss her.

Conway’s repeated violations, “combined with her unrepentant attitude, are unacceptable from any federal employee, let alone one in such a prominent position,” Kerner testified.

Representative Elijah Cummings (D., Md.), who chairs the Committee, said he is prepared to hold Conway in contempt if she defies the subpoena.

The info is here.

How do you teach a machine right from wrong? Addressing the morality within Artificial Intelligence

Joseph Brean
The Kingston Whig Standard
Originally published May 30, 2019

Here is an excerpt:

AI “will touch or transform every sector and industry in Canada,” the government of Canada said in a news release in mid-May, as it named 15 experts to a new advisory council on artificial intelligence, focused on ethical concerns. Their goal will be to “increase trust and accountability in AI while protecting our democratic values, processes and institutions,” and to ensure Canada has a “human-centric approach to AI, grounded in human rights, transparency and openness.”

It is a curious project, helping computers be more accountable and trustworthy. But here we are. Artificial intelligence has disrupted the basic moral question of how to assign responsibility after decisions are made, according to David Gunkel, a philosopher of robotics and ethics at Northern Illinois University. He calls this the “responsibility gap” of artificial intelligence.

“Who is able to answer for something going right or wrong?” Gunkel said. The answer, increasingly, is no one.

It is a familiar problem that is finding new expressions. One example was the 2008 financial crisis, which reflected the disastrous scope of automated decisions. Gunkel also points to the success of Google’s AlphaGo, a computer program that has beaten the world’s best players at the famously complex board game Go. Go has too many possible moves for a computer to calculate and evaluate them all, so the program uses a strategy of “deep learning” to reinforce promising moves, thereby approximating human intuition. So when it won against the world’s top players, such as top-ranked Ke Jie in 2017, there was confusion about who deserved the credit. Even the programmers could not account for the victory. They had not taught AlphaGo to play Go. They had taught it to learn Go, which it did all by itself.

The info is here.