Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Pan, L., Gao, B., Zhu, J., & Guo, J. (2023).

JAMA network open, 6(12), e2349258.

https://doi.org/10.1001/jamanetworkopen.2023.49258

Key Points

Question

Is an experience of negative wealth shock—a loss of 75% or more in total wealth over a 2-year period—associated with cognitive decline and dementia risks among middle-aged and older US adults?

Findings

In this cohort study of 8082 participants, those with negative wealth shock had faster decline in cognition and elevated risks of dementia when compared with those who had positive wealth without shock.

Meaning

These findings suggest that negative wealth shock is a risk factor for cognitive decline and dementia in middle-aged and older adults.

The research is linked above.

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Key findings:

• Negative wealth shock, defined as losing 75% or more of total wealth within two years, was associated with accelerated cognitive decline and higher risks of dementia.
• This association was stronger for younger participants (under 65) and white participants compared to older and non-white participants.

While the study offers valuable insights, it also has limitations:

• The study is observational, not causal, so it cannot prove cause and effect.
• Wealth changes after negative wealth shock were not considered, potentially impacting results.

Overall, the study suggests that negative wealth shock may be a risk factor for cognitive decline and dementia, highlighting the potential impacts of financial hardship on brain health. Further research is needed to confirm these findings and explore underlying mechanisms.

Additional points:

• The study used data from the Health and Retirement Study, which tracked over 8,000 participants for 14 years.
• Participants with negative wealth shock had a 27% higher risk of developing dementia compared to those without wealth shock.

The study suggests potential social and psychological mechanisms linking financial hardship to cognitive decline, such as stress, depression, and reduced access to healthcare.

Lawsuit Challenges New Jersey’s Out-of-State Telehealth Licensing Law

A. Vaidya

mhealthintelligence.com

Originally posted 18 DEC 23

Here is an excerpt:

The lawsuit states that J.A. was diagnosed with pineoblastoma, an aggressive brain tumor, at 18 months old. His physicians referred him to MacDonald in Boston. The treatment enabled J.A. to beat his cancer. However, he must continue to undergo scans once a year for the rest of his life to monitor the cancer’s return.

New Jersey’s current telehealth licensing law requires patients seeking specialty care out of state to decide whether to incur the cost of traveling to meet with the specialist for initial or follow-up consultations.

“Without telemedicine, patients suffering from rare cancers and diseases like J.A. must either forego lifesaving treatment or suffer by traveling out of state every time an appointment with a national specialist like Dr. MacDonald is needed,” the suit states. “Many cannot bear the burdens of frequent travel.”

Without the option of telehealth, J.A. and his family would not have been able to consult with all the specialists they needed due to “financial and time constraints,” the lawsuit further states. Even more recently, telehealth enabled J.A. to consult with MacDonald when an anomaly appeared on one of his scans.

Maintaining multiple licenses in different states places an administrative and financial burden on physicians, especially for specialists like MacDonald and Gardner, “who have national practices and only occasionally consult with or treat patients from New Jersey,” the suit notes.

Thus, the lawsuit argues that the licensing law violates the Dormant Commerce Clause and Privileges and Immunities Clause, which prohibits states from enacting laws that excessively burden interstate commerce in relation to local benefits. It also violates the First Amendment, which prevents the government from restricting conversations between patients and their providers, and the 14th Amendment’s Due Process Clause, which bans the government from limiting the ability of parents to direct their children’s medical care.

“Plaintiffs, who are New Jersey citizens and out-of-state specialists with patients in New Jersey, seek to vindicate their constitutional rights — and ensure they can continue to provide and receive — lifesaving care,” the lawsuit states.

The article is here.

Two in three UK doctors suffer ‘moral distress’ due to overstretched NHS, study finds

Denis Campbell

The Guardian

Originally posted 28 Dec 23

Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found.

Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill.

A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS.

Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said.

“There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association.

The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added.

“In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said.

The info is here.

Key points:

The study also found that:

• Nearly half (47%) of doctors believe the cost of living crisis is contributing to their moral distress.
• 72% of doctors say being unhappy at work has affected their mental health.
• 85% of doctors have experienced fatigue as a result of their work.

Causes of moral distress:

• Doctors are often in situations where they have to make difficult decisions about who to treat first, or whether they can afford to give a patient the treatment they need.
• They may also feel that they are not able to provide the level of care that they would like to because of the lack of resources in the NHS.

Impact of moral distress:

• Moral distress can lead to burnout, depression, and anxiety.
• It can also make it difficult for doctors to continue working in the NHS.

Americans are lonely and it’s killing them. How the US can combat this new epidemic.

Adrianna Rodriguez

USA Today

Originally posted 24 Dec 23

America has a new epidemic. It can’t be treated using traditional therapies even though it has debilitating and even deadly consequences.

The problem seeping in at the corners of our communities is loneliness and U.S. Surgeon General Dr. Vivek Murthy is hoping to generate awareness and offer remedies before it claims more lives.

“Most of us probably think of loneliness as just a bad feeling,” he told USA TODAY. “It turns out that loneliness has far greater implications for our health when we struggle with a sense of social disconnection, being lonely or isolated.”

Loneliness is detrimental to mental and physical health, experts say, leading to an increased risk of heart disease, dementia, stroke and premature death. As researchers track record levels of self-reported loneliness, public health leaders are banding together to develop a public health framework to address the epidemic.

“The world is becoming lonelier and there’s some very, very worrisome consequences,” said Dr. Jeremy Nobel, founder of The Foundation for Art and Healing, a nonprofit that addresses public health concerns through creative expression, which launched an initiative called Project Unlonely.

“It won’t just make you miserable, but loneliness will kill you," he said. "And that’s why it’s a crisis."

The info is here.

Key points:

• Loneliness Crisis: America faces a growing epidemic of loneliness impacting mental and physical health, leading to increased risks of heart disease, dementia, stroke, and premature death.
• Diverse and Widespread: Loneliness affects various demographics, from young adults to older populations, and isn't limited by social media interaction.
• Health Risks: The Surgeon General reports loneliness raises risk of premature death by 26%, equivalent to smoking 15 cigarettes daily. Heart disease and stroke risks also increase significantly.
• Causes: Numerous factors contribute, including societal changes, technology overuse, remote work, and lack of genuine social connection.
• Solutions: Individual actions like reaching out and mindful interactions help. Additionally, public health strategies like "social prescribing" and community initiatives are crucial.
• Collective Effort Needed: Overcoming the epidemic requires collaboration across sectors, fostering stronger social connections within communities and digital spaces.

Alcohol overuse causes 140,000 American deaths annually. Why is it so undertreated?

Melinda Fawcett

Psychiatry.ufl.edu

Originally posted 28 Nov 23

Here is an excerpt:

How to treat the disorder

In the last decade, the medical community has come to recognize AUD as a disease that (like all others) needs medical treatment through a range of interventions. With new treatments coming out every day, hope exists that in the years to come more and more people will receive the care they need.

For those with the most severe forms of AUD, treatment aims at stopping the individual’s alcohol consumption entirely (while recognizing that having a drink or breaking abstinence isn’t a failure, but an almost inevitable part of the recovery cycle).

“What’s happened in the last probably 50 years or so is there’s a more medicalized understanding,” said Humphreys. “So there’s been the rise of neuroscience that looks at things like how the brain changes with repeated administration of alcohol, how that limits things like self-control, how that increases phenomena like craving.”

And as with any other mental health diagnosis, successful treatment for AUD often boils down to a combination of therapy and medication, the experts Vox spoke to said. Just as depression is treated with medication to balance chemicals in the brain, and therapy to help patients unlearn harmful behaviors, AUD often needs the same combination of treatments, said Disselkoen.

The Federal Drug Administration approved the first medication to treat AUD, disulfiram, in 1951. Disulfiram, whose brand name is Antabuse, is a daily pill that causes someone to fall ill — face redness, headache, nausea, sweating, and more — if they drink even a small amount of alcohol. Disulfiram is safe and effective, but the same characteristic that makes it successful (the way it induces illness) also makes it unpopular among patients, said Nixon.

The info is here.

Key points:

• Alarming death toll: 140,000 Americans die annually from alcohol overuse, highlighting a major public health crisis.
• Undertreatment disparity: Unlike other dangerous substances, alcohol issues lack the same attention and treatment resources.
• Neurological changes: Repeated alcohol misuse alters the brain, making it a serious health condition, not just a social issue.
• Market forces: The powerful alcohol industry and its growing revenue contribute to lax regulations and limited intervention.
• Policy gap: Inadequate taxation fails to curb consumption, while other harmful substances face stricter controls.
• Blind spot in drug policy: Recognizing alcohol as a harmful drug with addiction potential is crucial for tackling the problem.

This Is Your Brain on Zoom

Leah Croll

MedScape.com

Originally posted 21 Dec 23

Here is an excerpt:

Zoom vs In-Person Brain Activity

The researchers took 28 healthy volunteers and recorded multiple neural response signals of them speaking in person vs on Zoom to see whether face-processing mechanisms differ depending upon social context. They used sophisticated imaging and neuromonitoring tools to monitor the real-time brain activity of the same pairs discussing the same exact things, once in person and once over Zoom.

When study participants were face-to-face, they had higher levels of synchronized neural activity, spent more time looking directly at each other, and demonstrated increased arousal (as indicated by larger pupil diameters), suggestive of heightened engagement and increased mutual exchange of social cues. In keeping with these behavioral findings, the study also found that face-to-face meetings produced more activation of the dorsal-parietal cortex on functional near-infrared spectroscopy. Similarly, in-person encounters were associated with more theta oscillations seen on electroencephalography, which are associated with face processing. These multimodal findings led the authors to conclude that there are probably separable neuroprocessing pathways for live faces presented in person and for the same live faces presented over virtual media.

It makes sense that virtual interfaces would disrupt the exchange of social cues. After all, it is nearly impossible to make eye contact in a Zoom meeting; in order to look directly at your partner, you need to look into the camera where you cannot see your partner's expressions and reactions. Perhaps current virtual technology limits our ability to detect more subtle facial movements. Plus, the downward angle of the typical webcam may distort the visual information that we are able to glean over virtual encounters. Face-to-face meetings, on the other hand, offer a direct line of sight that allows for optimal exchange of subtle social cues rooted in the eyes and facial expressions.

The info is here.

Key findings:

• Zoom meetings are less stimulating for the brain than face-to-face interactions. A study by Yale University found that brain activity associated with social processing is lower during Zoom calls compared to in-person conversations.
• Reduced social cues on Zoom lead to increased cognitive effort. The lack of subtle nonverbal cues, like facial expressions and body language, makes it harder to read others and understand their intentions on Zoom. This requires the brain to work harder to compensate.
• Constant video calls can be mentally taxing. Studies have shown that back-to-back Zoom meetings can increase stress and fatigue. This is likely due to the cognitive demands of processing visual information and the constant pressure to be "on."

Implications:

• Be mindful of Zoom fatigue. Schedule breaks between meetings and allow time for your brain to recover.
• Use Zoom strategically. Don't use Zoom for every meeting or interaction. When possible, opt for face-to-face conversations.
• Enhance social cues on Zoom. Use good lighting and a clear webcam to make it easier for others to see your face and expressions. Use gestures and nonverbal cues to communicate more effectively.

Listen, explain, involve, and evaluate: why respecting autonomy benefits suicidal patients

Samuel J. Knapp (2024)

Ethics & Behavior, 34:1, 18-27

DOI: 10.1080/10508422.2022.2152338

Abstract

Out of a concern for keeping suicidal patients alive, some psychotherapists may use hard persuasion or coercion to keep them in treatment. However, more recent evidence-supported interventions have made respect for patient autonomy a cornerstone, showing that the effective interventions that promote the wellbeing of suicidal patients also prioritize respect for patient autonomy. This article details how psychotherapists can incorporate respect for patient autonomy in the effective treatment of suicidal patients by listening to them, explaining treatments to them, involving them in decisions, and inviting evaluations from them on the process and progress of their treatment. It also describes how processes that respect patient autonomy can supplement interventions that directly address some of the drivers of suicide.

Public Impact Statement

Treatments for suicidal patients have improved in recent years, in part, because they emphasize promoting patient autonomy. This article explains why respecting patient autonomy is important in the treatment of suicidal patients and how psychotherapists can integrate respect for patient autonomy in their treatments.

My lengthy summary, because the article is paywalled here.

Dr. Knapp's article discusses the importance of respecting patient autonomy in the treatment of suicidal patients within the framework of principle-based ethics. It highlights the ethical principles of beneficence, nonmaleficence, justice, respecting patient autonomy, and professional-patient relationships. The article emphasizes the challenges psychotherapists face in balancing the promotion of patient well-being with the need to respect autonomy, especially when dealing with suicidal patients.

Fear and stress in treating suicidal patients may lead psychotherapists to prioritize more restrictive interventions, potentially disregarding the importance of patient autonomy. The article argues that actions minimizing respect for patient autonomy may reflect a paternalistic attitude, which is implementing interventions without patient consent for the sake of well-being.

The problems associated with paternalistic interventions are discussed, emphasizing the importance of patients' internal motivation to change. The article advocates for autonomy-focused interventions, such as cognitive behavior therapy and dialectical behavior therapy, which have been shown to reduce suicide risk and improve outcomes. It suggests that involving patients in treatment decisions, listening to their experiences, and validating their feelings contribute to more effective interventions.

The article provides recommendations on how psychotherapists can respect patient autonomy, including listening carefully to patients, explaining treatment processes, involving patients in decisions, and inviting them to evaluate their progress. The ongoing nature of the informed consent process is stressed, along with the benefits of incorporating patient feedback into treatment. The article concludes by acknowledging the need for a balance between beneficence and respect for patient autonomy, particularly in cases of imminent danger, where temporary prioritization of beneficence may be necessary.

In summary, the article underscores the significance of respecting patient autonomy in the treatment of suicidal patients and provides practical guidance for psychotherapists to achieve this while promoting patient well-being.

Salve Lucrum: The Existential Threat of Greed in US Health Care

Berwick DM.

JAMA. 2023;329(8):629–630.

doi:10.1001/jama.2023.0846

Here is an excerpt:

Particularly costly has been profiteering among insurance companies participating in the Medicare Advantage (MA) program. Originally intended to give Medicare beneficiaries the choice of access to well-managed care at lower cost, MA has mushroomed into a massive program, now about to cover more than 50% of all Medicare beneficiaries and costing far more per beneficiary than traditional Medicare ever has. By gaming Medicare risk codes and the ways in which comparative “benchmarks” are set for expected costs, MA plans have become by far the most profitable branches of large insurance companies. According to some health services research, MA will cost Medicare over $600 billion more in the next 8 years than would have been the case if the same enrollees had remained in traditional Medicare. Opinions differ about whether MA enrollees experience better care and outcomes than those in traditional Medicare, but the weight of evidence is that they do not.

Hospital pricing games are also widespread. Hospitals claim large operating losses, especially in the COVID pandemic period, but large systems sit on balance sheets with tens of billions of dollars in the bank or invested. Hospital prices for the top 37 infused cancer drugs averaged 86.2% higher per unit than in physician offices. A patient was billed $73 800 at the University of Chicago for 2 injections of Lupron depot, a treatment for prostate cancer, a drug available in the UK for $260 a dose. To drive up their own revenues, many hospitals serving wealthy populations take advantage of a federal subsidy program originally intended to reduce drug costs for people with low income.

Recent New York Times investigations have reported on nonprofit hospitals’ reducing and closing services in poor areas while opening new ones in wealthy suburbs and on their use of collection agencies for pursuing payment from patients with low income. The Massachusetts Health Policy Commission reported in 2022 that hospital prices and revenues increased during a decade at almost 4 times the rate of inflation.

Windfall profits also appear in salaries and benefits for many health care executives. Of the 10 highest paid among all corporate executives in the US in 2020, 3 were from Oak Street Health, and salary and benefits included, reportedly, $568 million for the chief executive officer (CEO). Executives in large hospital systems commonly have salaries and benefits of several million dollars a year. Some academic medical centers’ boards allow their CEO to serve for 6-figure stipends and multimillion-dollar stock options on outside company boards, including ones that supply products and services to the medical center.

The info is here.

My summary and warnings are here:

Greed is not good, especially in healthcare. This article outlines the concerning issue of greed pervading the US healthcare system. It argues that prioritizing profit over patient well-being has become widespread, impacting everything from drug companies to hospitals. The author contends that this greed is detrimental to both patients and the healthcare system as a whole. To address this, the article proposes solutions like fostering greater transparency and accountability, along with reevaluating how healthcare is financed.

What Is It That You Want Me To Do? Guidance for Ethics Consultants in Complex Discharge Cases

Omelianchuk, A., Ansari, A.A. & Parsi, K.

HEC Forum (2023).

https://doi.org/10.1007/s10730-023-09517-y

Abstract

Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which we call “complex discharges,” are beset with tensions between the interests of the institution and the interests of the patient as well as tensions within the ethics consultant whose commitments are shaped both by the values of the organization and the values of their own profession. The clinical ethics literature on this topic is limited and provides little guidance. What is needed is guidance for consultants operating at the bedside and for those participating at a higher organizational level. To fill this gap, we offer guidance for facilitating a fair process designed to resolve the conflict without resorting to coercive legal measures. We reflect on three cases to argue that the approach of the consultant is generally one of mediation in these types of disputes. For patients who lack decision making capacity and lack a surrogate decision maker, we recommend the creation of a complex discharge committee within the organization so that ethics consultants can properly discharge their duties to assist patients who are unable to advocate for themselves through a fair and transparent process.

The article is paywalled.  Please contact the author for full copy.

Here is my summary:

• Ethics consultants face diverse patient situations, including lack of desire to leave, potential mental health issues, and financial/space constraints.
• Fair discharge processes are crucial, through mediation or multidisciplinary committees, balancing patient needs with system limitations.
• "Conveyor belt" healthcare can strain trust and create discharge complexities.
• The ethics consultant role is valuable but limited, suggesting standing "complex case committees" with diverse expertise for effective, creative solutions.

In essence, this summary highlights the need for a more nuanced and collaborative approach to complex discharges, prioritizing patient well-being while recognizing systemic constraints.

Deciding for Patients Who Have Lost Decision-Making Capacity — Finding Common Ground in Medical Ethics

Bernard Lo

The New England Journal of Medicine

Originally published 16 Dec 23

Here is an excerpt:

Empirical studies...show that advance directives do not work as was hoped.2 Only a minority of patients complete them. Directives commonly are not well informed, because patients have serious misconceptions about life-sustaining interventions and about their own prognoses. Designated surrogates are often inaccurate in stating patients’ preferences in specific scenarios. Patient preferences commonly change over time. Patients often want surrogates to have leeway to override their prior statements. And when making decisions, surrogates frequently consider aspects of patient well-being to be more important than the patient’s previously stated preferences.

Conceptually, relying completely on an incompetent patient’s prior directives may be unsound. Often surrogates must extrapolate from the patient’s previous directives and statements to a situation that the patient did not foresee. Patients generally underestimate how well they can cope with and adapt to new situations.

So the standard approach shifted to advance care planning, a process for helping adults understand and communicate their values, goals, and preferences regarding future care. Advance care planning improves satisfaction with communication and reduces the risk of post-traumatic stress disorder, depression, or anxiety among surrogate decision makers.3 However, its use neither increases the likelihood that decisions are concordant with patients’ values and goals nor improves patients’ quality of life.3

Studies show that patients are less concerned about specific medical interventions than about clinical outcomes, burdens, and quality of life. Such evidence led advocates of advance care planning to begin focusing on preparing for in-the-moment decisions rather than documenting directives for medical interventions.

Many state legislatures rejected the strict requirements for surrogate decision making that Cruzan allowed. By 2004, 10 states allowed patients to appoint a health care proxy in a conversation with a physician as well as in formal documents. By 2016, 41 states — both conservative and liberal — had enacted laws allowing family members to act as health care surrogates for patients who lacked decision-making capacity and had not designated a health care proxy. Seven states included domestic partners or close friends on the list of acceptable surrogates.

The info is here.

Here is a quick summary:

Following the 1990 Supreme Court's Cruzan ruling, which emphasized clear evidence for life-sustaining treatment withdrawal, practices shifted. Advance directives like living wills gained popularity, but studies revealed their limitations. Advance care planning, focusing on communication and values, took hold. POLST forms were introduced for specific interventions, but studies show inconsistency with actual situations.

The emphasis is now on family decision-making and flexible guidelines. Rigid legal formalities have decreased, and surrogates consider not just past directives but also current situations and evolving values. Discussions involving patients, surrogates, and physicians are crucial. Different approaches like past commitments, current well-being, and "life story continuation" may be appropriate depending on the context.

The Cruzan framework is no longer the basis for medical ethics and law. Family decisions, flexible standards, and evolving values now guide care. This shift showcases how medical ethics can adapt through discussions, research, and legal changes. Finding common ground on critical issues in today's divided society remains a challenge, but it's more important than ever.

Doctors With Histories of Big Malpractice Settlements Now Work for Insurers

P. Rucker, D. Armstrong, & D. Burke

Propublica.org

Originally published 15 Dec 23

Here is an excerpt:

Patients and the doctors who treat them don’t get to pick which medical director reviews their case. An anesthesiologist working for an insurer can overrule a patient’s oncologist. In other cases, the medical director might be a doctor like Kasemsap who has left clinical practice after multiple accusations of negligence.

As part of a yearlong series about how health plans refuse to pay for care, ProPublica and The Capitol Forum set out to examine who insurers picked for such important jobs.

Reporters could not find any comprehensive database of doctors working for insurance companies or any public listings by the insurers who employ them. Many health plans also farm out medical reviews to other companies that employ their own doctors. ProPublica and The Capitol Forum identified medical directors through regulatory filings, LinkedIn profiles, lawsuits and interviews with insurance industry insiders. Reporters then checked those names against malpractice databases, state licensing board actions and court filings in 17 states.

Among the findings: The Capitol Forum and ProPublica identified 12 insurance company doctors with either a history of multiple malpractice payments, a single payment in excess of $1 million or a disciplinary action by a state medical board.

One medical director settled malpractice cases with 11 patients, some of whom alleged he bungled their urology surgeries and left them incontinent. Another was reprimanded by a state medical board for behavior that it found to be deceptive and dishonest. A third settled a malpractice case for $1.8 million after failing to identify cancerous cells on a pathology slide, which delayed a diagnosis for a 27-year-old mother of two, who died less than a year after her cancer was finally discovered.

None of this would have been easily visible to patients seeking approvals for care or payment from insurers who relied on these medical directors.

The info is here.

The ethical implications in this article are staggering.  Here are some quick points:

Conflicted Care: In a concerning trend, some US insurers are employing doctors with past malpractice settlements to assess whether patients deserve coverage for recommended treatments.  So, do these still licensed reviewers actually understand best practices?

Financial Bias: Critics fear these doctors, having faced financial repercussions for past care decisions, might prioritize minimizing payouts over patient needs, potentially leading to denied claims and delayed care.  In other words, do the reviewers have an inherent bias against patients, given that former patients complained against them?

Transparency Concerns: The lack of clear disclosure about these doctors' backgrounds raises concerns about transparency and potential conflicts of interest within the healthcare system.

In essence, this is a horrible system to provide high quality medical review.

Private equity is buying up health care, but the real problem is why doctors are selling

Yashaswini Singh & Christopher Whaley

The Hill

Originally published 21 Dec 23

Here is an excerpt:

But amid warnings that private equity is taking over health care and portrayals of financiers as greedy villains, we’re ignoring the reality that no one is coercing individual physicians to sell. Many doctors are eager to hand off their practices, and for not just for the payday. Running a private practice has become increasingly unsustainable, and alternative employment options, such as working for hospitals, are often unappealing. That leaves private equity as an attractive third path.

There are plenty of short-term steps that regulators should take to keep private equity firms in check. But the bigger problem we must address is why so many doctors feel the need to sell. The real solution to private equity in health care is to boost competition and address the pressures physicians are facing.

Consolidation in health care isn’t new. For decades, physician practices have been swallowed up by hospital systems. According to a study by the Physicians Advocacy Institute, nearly 75 percent of physicians now work for a hospital or corporate owner. While hospitals continue to drive consolidation, private equity is ramping up its spending and market share. One recent report found that private equity now owns more than 30 percent of practices in nearly one-third of metropolitan areas.

Years of study suggest that consolidation drives up health care costs without improving quality of care, and our research shows that private equity is no different. To deliver a high return to investors, private equity firms inflate charges and cut costs. One of our studies found that a few years after private equity invested in a practice, charges per patient were 50% higher than before. Practices also experience high turnover of physicians and increased hiring of non-physician staff.

How we got here has more to do with broader problems in health care than with private equity itself.

The info is here.

Here is my summary, which is really a warning:

The article dives into the concerning trend of private equity firms acquiring healthcare practices. It argues that while this might seem concerning, the bigger issue lies in understanding why doctors are willing to sell their practices in the first place.

The author highlights the immense financial burden doctors shoulder while running their own practices. Between rising costs and stagnant insurance reimbursements, it's becoming increasingly difficult for them to stay afloat. This, the article argues, is what's pushing them towards private equity firms, who offer immediate financial relief but often come with their own set of downsides for patients, like higher costs and reduced quality of care.

Therefore, instead of solely focusing on restricting private equity involvement, the article suggests we address the root cause: the financial woes of independent doctors. This could involve solutions like increased Medicare payments, tax breaks for independent practices, and alleviating the administrative burden doctors face. Only then can we ensure a sustainable healthcare system that prioritizes patient well-being.

Asexuality Is Finally Breaking Free from Medical Stigma

Allison Parshall

Scientific American

Originally posted 1 Jan 24

Here is an excerpt:

Over the past two decades psychological studies have shown that asexuality should be classified not as a disorder but as a stable sexual orientation akin to homosexuality or heterosexuality. Both cultural awareness and clinical medicine have been slow to catch on. It's only recently that academic researchers have begun to look at asexuality not as an indicator of health problems but as a legitimate, underexplored way of being human.

In biology, the word “asexual” typically gets used in reference to species that reproduce without sex, such as bacteria and aphids. But in some species that do require mating to have offspring, such as sheep and rodents, scientists have observed individuals that don't appear driven to engage in the act.

This behavior is more analogous to human asexuality, a concept rarely mentioned in medical literature until recently. In a pamphlet published in 1896, pioneering German sexologist Magnus Hirschfeld described people without sexual desire, a state he called “anesthesia sexualis.” In 1907 Reverend Carl Schlegel, an early gay rights activist, advocated for the “same laws” for “the homosexuals, heterosexuals, bisexuals [and] asexuals.” When sexologist Alfred Kinsey devised his scale of sexual orientation in the 1940s, he created a “Category X” for the respondents who unexpectedly reported no sociosexual contacts or reactions—exceptions from his model whom he estimated made up 1.5 percent of all males between the ages of 16 and 55 in the U.S. Asexuality was largely absent from scientific research over the subsequent decades, although it was occasionally referenced by activists and scholars in the gay liberation movement.

The info is here.

Here are some quick bullet points:

• Asexuality is a sexual orientation characterized by a lack of sexual attraction to others.
• In the past, asexuality was often misunderstood and misdiagnosed as a mental health disorder.
• Today, asexuality is increasingly recognized as a legitimate sexual orientation.
• People who identify as asexual may or may not experience sexual attraction, and there is a spectrum of asexuality.
• Asexual people can face challenges in getting proper medical care, as some healthcare providers may not be familiar with asexuality.

Biden administration rescinds much of Trump ‘conscience’ rule for health workers

Nathan Weixel

The Hill

Originally published 9 Jan 24

The Biden administration will largely undo a Trump-era rule that boosted the rights of medical workers to refuse to perform abortions or other services that conflicted with their religious or moral beliefs.

The final rule released Tuesday partially rescinds the Trump administration’s 2019 policy that would have stripped federal funding from health facilities that required workers to provide any service they objected to, such as abortions, contraception, gender-affirming care and sterilization.

The health care conscience protection statutes represent Congress’s attempt to strike a balance between maintaining access to health care and honoring religious beliefs and moral convictions, the Department of Health and Human Services said in the rule.

“Some doctors, nurses, and hospitals, for example, object for religious or moral reasons to providing or referring for abortions or assisted suicide, among other procedures. Respecting such objections honors liberty and human dignity,” the department said.

But at the same time, Health and Human Services said “patients also have rights and health needs, sometimes urgent ones. The Department will continue to respect the balance Congress struck, work to ensure individuals understand their conscience rights, and enforce the law.”

The info is here.

Summary from Healthcare Dive

The HHS Office of Civil Rights has again updated guidance on providers’ conscience rights. The latest iteration, announced on Tuesday, aims to strike a balance between honoring providers’ religious and moral beliefs and ensuring access to healthcare, according to the agency.

President George W. Bush created conscience rules in 2008, which codify the rights of healthcare workers to refuse to perform medical services that conflict with their religious or moral beliefs. Since then, subsequent administrations have rewritten the rules, with Democrats limiting the scope and Republicans expanding conscience protections. 

The most recent revision largely undoes a 2019 Trump-era policy — which never took effect — that sought to expand the rights of healthcare workers broadly to refuse to perform medical services, such as abortions, on religious or moral grounds.

Trump Is Coming for Obamacare Again

Ronald Brownstein

The Atlantic

Originally posted 10 Jan 24

Donald Trump’s renewed pledge on social media and in campaign rallies to repeal and replace the Affordable Care Act has put him on a collision course with a widening circle of Republican constituencies directly benefiting from the law.

In 2017, when Trump and congressional Republicans tried and failed to repeal the ACA, also known as Obamacare, they faced the core contradiction that many of the law’s principal beneficiaries were people and institutions that favored the GOP. That list included lower-middle-income workers without college degrees, older adults in the final years before retirement, and rural communities.

The info is paywalled here.

Here's the gist:

• Trump's stance: He believes Obamacare is a "catastrophe" and wants to replace it with "MUCH BETTER HEALTHCARE."
• Challenges: Repealing Obamacare is likely an uphill battle. Its popularity has increased, and even some Republicans benefit from the law.
• Potential consequences: If Trump succeeds, millions of Americans could lose their health insurance, while others face higher premiums.
• Political implications: Trump's renewed focus on Obamacare could energize his base but alienate moderate voters.

Criminal Justice Reform Is Health Care Reform

Haber LA, Boudin C, Williams BA.

JAMA.

Published online December 14, 2023.

doi:10.1001/jama.2023.25005

Here is an excerpt:

Health Care While Incarcerated

Federal law mandates provision of health care for incarcerated persons. In 1976, the US Supreme Court ruled in Estelle v Gamble that “deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’” prohibited under the Eighth Amendment. Subsequent cases established that incarcerated individuals must receive access to medical care, enactment of ordered care, and treatment without bias to their incarcerated status.

Such court decisions establish rights and responsibilities, but do not fund or oversee health care delivery. Community health care oversight, such as the Joint Commission, does not apply to prison health care. When access to quality care is inadequate, incarcerated patients must resort to lawsuits to advocate for change—a right curtailed by the Prison Litigation Reform Act of 1996, which limited prisoners’ ability to file suit in federal court.

Despite Eighth Amendment guarantees, simply entering the criminal-legal system carries profound personal health risks: violent living conditions result in traumatic injuries, housing in congregate settings predisposes to the spread of infectious diseases, and exceptions to physical comfort, health privacy, and informed decision-making occur during medical care delivery. These factors compound existing health disparities commonly found in the incarcerated population.

The First Step Act

Signed under then-president Trump, the First Step Act of 2018 (FSA) was a bipartisan criminal justice reform bill designed to reduce the federal prison population while also protecting public safety. The legislation aimed to decrease entry into prison, provide rehabilitation during incarceration, improve protections for medically vulnerable individuals, and expedite release.

To achieve these goals, the FSA included prospective and retroactive sentencing reforms, most notably expanded relief from mandatory minimum sentences for drug distribution offenses that disproportionately affect Black individuals in the US. The FSA additionally called for the use of evidence-based tools, such as the Prisoner Assessment Tool Targeting Estimated Risk and Needs, to facilitate release decisions.

The legislation also addressed medical scenarios commonly encountered by professionals providing care to incarcerated persons, including prohibitions on shackling pregnant patients, deescalation training for correctional officers when encountering people with psychiatric illness or cognitive deficits, easing access to compassionate release for those with advanced age or life-limiting illness, and mandatory reporting on the use of medication-assisted treatment for opioid use disorder. With opioid overdose being the leading cause of postrelease mortality, the latter requirement has been particularly important for those transitioning out of correctional settings.

During the recent COVID-19 pandemic, FSA amendments expanding incarcerated individuals’ access to the courts led to a marked increase in successful petitions for early release from prison. Decarcerating those individuals most medically at risk during the public health crisis reduced the spread of viral illness associated with prison overcrowding, protecting both incarcerated individuals and those working in carceral settings.

The info is here.

The man helping prevent suicide with Google adverts

Looi, M.-K. (2023).

BMJ.

https://doi.org/10.1136/bmj.p2847 

Here are two excerpts:

Always online

A big challenge in suicide prevention is that people often experience suicidal crises at times when they’re away from clinical facilities, says Nick Allen, professor of psychology at the University of Oregon.

“It’s often in the middle of the night, so one of the great challenges is how can we be there for someone when they really need us, which is not necessarily when they’re engaged with clinical services.”

Telemedicine and other digital interventions came to prominence at the height of the pandemic, but “there’s an app for that” does not always match the patient in need at the right time. Says Onie, “The missing link is using existing infrastructure and habits to meet them where they are.”

Where they are is the internet. “When people are going through suicidal crises they often turn to the internet for information. And Google has the lion’s share of the search business at the moment,” says Allen, who studies digital mental health interventions (and has had grants from Google for his research).

Google’s core business stores information from searches, using it to fuel a highly effective advertising network in which companies pay to have links to their websites and products appear prominently in the “sponsored” sections at the top of all relevant search results.

The company holds 27.5% of the digital advertising market—earning the company around $224bn from search advertising alone in 2022.

If it knows enough about us to serve up relevant adverts, then it knows when a user is displaying red flag behaviour for suicide. Onie set out to harness this.

“It’s about the ‘attention economy,’” he says, “There’s so much information, there’s so much noise. How do we break through and make sure that the first thing that people see when they’re contemplating suicide is something that could be helpful?”

(cut)

At its peak the campaign was responding to over 6000 searches a day for each country. And the researchers saw a high level of response.

Typically, most advertising campaigns see low engagement in terms of clickthrough rates (the number of people that actually click on an advert when they see it). Industry benchmarks consider 3.17% a success. The Black Dog campaign saw 5.15% in Australia and 4.02% in the US. Preliminary data show Indonesia to be even higher—as much as 12%.

Because this is an advertising campaign, another measure is cost effectiveness. Google charges the advertiser per click on its advert, so the more engaged an audience is (and thus what Google considers to be a relevant advert to a relative user) the higher the charge. Black Dog’s campaign saw such a high number of users seeing the ads, and such high numbers of users clicking through, that the cost was below that of the industry average of $2.69 a click—specifically, $2.06 for the US campaign. Australia was higher than the industry average, but early data indicate Indonesia was delivering $0.86 a click.

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I could not find a free pdf.  The link above works, but is paywalled. Sorry. :(

Google is Free: Moral Evaluations of Intergroup Curiosity

Mosley, A. J., & Solomon, L. H. (2023).

Personality and Social Psychology Bulletin, 0(0).

https://doi.org/10.1177/01461672231180149

Abstract

Two experiments investigated how evaluations of intergroup curiosity differed depending on whether people placed responsibility for their learning on themselves or on outgroup members. In Study 1, participants (n = 340; 51% White-American, 49% Black-American) evaluated White actors who were curious about Black culture and placed responsibility on outgroup members to teach versus on themselves to learn. Both Black and White participants rated the latter actors as more moral, and perceptions of effort mediated this effect. A follow-up preregistered study (n = 513; 75% White-American) asked whether perceptions of greater effort cause greater perceptions of moral goodness. Replicating Study 1, participants rated actors as more moral when they placed responsibility on themselves versus others. Participants also rated actors as more moral when they exerted high versus low effort. These results clarify when and why participants view curiosity as morally good and help to strengthen bridges between work on curiosity, moral cognition, and intergroup relations.

A pdf is here.

Here is my summary:

The researchers found that people evaluate intergroup curiosity more favorably when they perceive that the curious individual is placing responsibility on themselves to learn rather than on the outgroup to teach. The researchers also found that perceptions of effort mediate this effect, such that people view curious individuals who exert greater effort as more moral. These findings suggest that people view intergroup curiosity as more morally good when they perceive that the curious individual is taking responsibility for their own learning and is putting in the effort to understand the outgroup.

Consciousness does not require a self

James Coook

iai.tv

Originally published 14 DEC 23

Here is an excerpt:

Beyond the neuroscientific study of consciousness, phenomenological analysis also reveals the self to not be the possessor of experience. In mystical experiences induced by meditation or psychedelics, individuals typically enter a mode of experience in which the psychological self is absent, yet consciousness remains. While this is not the default state of the mind, the presence of consciousness in the absence of a self shows that consciousness is not dependent on an experiencing subject. What is consciousness if not a capacity of an experiencing subject? Such an experience reveals consciousness to consist of a formless awareness at its core, an empty space in which experience arises, including the experience of being a self. The self does not possess consciousness, consciousness is the experiential space in which the image of a psychological self can appear. This mode of experience can be challenging to conceptualise but is very simple when experienced – it is a state of simple appearances arising without the extra add-on of a psychological self inspecting them.

We can think of a conscious system as a system that is capable of holding beliefs about the qualitative character of the world. We should not think of belief here as referring to complex conceptual beliefs, such as believing that Paris is the capital of France, but as the simple ability to hold that the world is a certain way. You do this when you visually perceive a red apple in front of you, the experience is one of believing the apple to exist with all of its qualities such as roundness and redness. This way of thinking is in line with the work of Immanuel Kant, who argued that we never come to know reality as it is but instead only experience phenomenal representations of reality [9]. We are not conscious of the world as it is, but as we believe it to be.

The info is here.

Here is my take:

For centuries, we've assumed consciousness and the sense of self are one and the same. This article throws a wrench in that assumption, proposing that consciousness can exist without a self. Imagine experiencing sights, sounds, and sensations without the constant "me" narrating it all. That's what "selfless consciousness" means – raw awareness untouched by self-reflection.

The article then posits that our familiar sense of self, complete with its stories and memories, isn't some fundamental truth but rather a clever prediction concocted by our brains. This "predicted self" helps us navigate the world and interact with others, but it's not necessarily who we truly are.

Decoupling consciousness from the self opens a Pandora's box of possibilities. We might find consciousness in unexpected places, like animals or even artificial intelligence. Understanding brain function could shift dramatically, and our very notions of identity, free will, and reality might need a serious rethink. This is a bold new perspective on what it means to be conscious, and its implications are quite dramatic.

Out, damned spot: Can the “Macbeth Effect” be replicated?

Earp, B. D., Everett, J. A. C., et al. (2014).

Basic and Applied Social Psychology, 36(1), 91–98.

https://doi.org/10.1080/01973533.2013.856792

Abstract

Comments on an article by Zhong, and Liljenquist (see record 2004-22267-003). Zhong and Liljenquist (2006) reported evidence of a “Macbeth Effect” in social psychology: a threat to people's moral purity leads them to seek, literally, to cleanse themselves. In an attempt to build upon these findings, we conducted a series of direct replications of Study 2 from Z&L's seminal report. We used Z&L's original materials and methods, investigated samples that were more representative of the general population, investigated samples from different countries and cultures, and substantially increased the power of our statistical tests. Despite multiple good-faith efforts, however, we were unable to detect a “Macbeth Effect” in any of our experiments. We discuss these findings in the context of recent concerns about replicability in the field of experimental social psychology.

A pdf is here.

Here is my summary:

In a seminal study published in 2006, Zhong and Liljenquist introduced the concept of the "Macbeth Effect," which suggests that moral transgressions lead to a desire for physical cleansing. This phenomenon was inspired by Shakespeare's play "Macbeth," in which Lady Macbeth's obsession with washing her hands reflects her guilt over her murderous actions.

Building on Zhong and Liljenquist's work, Earp et al. (2014) conducted a series of experiments to replicate the Macbeth Effect. They used various methods, including manipulating participants' moral states through writing tasks and exposing them to reminders of moral cleanliness. However, despite their efforts, they were unable to consistently find evidence for the Macbeth Effect.

The authors' inability to replicate the original findings raises questions about the robustness of the Macbeth Effect. They suggest that more research is needed to understand the conditions under which moral transgressions lead to a desire for physical cleansing. Additionally, they emphasize the importance of conducting replications in psychological research to ensure the reliability of findings.

The paucity of morality in everyday talk

Atari, M., Mehl, M.R., Graham, J. et al. 

Sci Rep 13, 5967 (2023).

https://doi.org/10.1038/s41598-023-32711-4

Abstract

Given its centrality in scholarly and popular discourse, morality should be expected to figure prominently in everyday talk. We test this expectation by examining the frequency of moral content in three contexts, using three methods: (a) Participants’ subjective frequency estimates (N = 581); (b) Human content analysis of unobtrusively recorded in-person interactions (N = 542 participants; n = 50,961 observations); and (c) Computational content analysis of Facebook posts (N = 3822 participants; n = 111,886 observations). In their self-reports, participants estimated that 21.5% of their interactions touched on morality (Study 1), but objectively, only 4.7% of recorded conversational samples (Study 2) and 2.2% of Facebook posts (Study 3) contained moral content. Collectively, these findings suggest that morality may be far less prominent in everyday life than scholarly and popular discourse, and laypeople, presume.

Summary

Overall, the findings of this research suggest that morality is far less prevalent in everyday talk than previously assumed. While participants overestimated the frequency of moral content in their self-reports, objective measures revealed that moral topics are relatively rare in everyday conversations and online interactions.

The study's authors propose several explanations for this discrepancy between subjective and objective findings. One possibility is that people tend to remember instances of moral talk more vividly than other types of conversation. Additionally, people may be more likely to report that they engage in moral talk when they are explicitly asked about it, as this may make them more aware of their own moral values.

Regardless of the underlying reasons, the findings of this research suggest that morality is not as prominent in everyday life as is often assumed. This may have implications for how we understand and promote moral behavior in society.

Indigenous data sovereignty—A new take on an old theme

Tahu Kukutai (2023).

Science, 382.

DOI:10.1126/science.adl4664

A new kind of data revolution is unfolding around the world, one that is unlikely to be on the radar of tech giants and the power brokers of Silicon Valley. Indigenous Data Sovereignty (IDSov) is a rallying cry for Indigenous communities seeking to regain control over their information while pushing back against data colonialism and its myriad harms. Led by Indigenous academics, innovators, and knowledge-holders, IDSov networks now exist in the United States, Canada, Aotearoa (New Zealand), Australia, the Pacific, and Scandinavia, along with an international umbrella group, the Global Indigenous Data Alliance (GIDA). Together, these networks advocate for the rights of Indigenous Peoples over data that derive from them and that pertain to Nation membership, knowledge systems, customs, or territories. This lens on data sovereignty not only exceeds narrow notions of sovereignty as data localization and jurisdictional rights but also upends the assumption that the nation state is the legitimate locus of power. IDSov has thus become an important catalyst for broader conversations about what Indigenous sovereignty means in a digital world and how some measure of self-determination can be achieved under the weight of Big Tech dominance.

Indigenous Peoples are, of course, no strangers to struggles for sovereignty. There are an estimated 476 million Indigenous Peoples worldwide; the actual number is unknown because many governments do not separately identify Indigenous Peoples in their national data collections such as the population census. Colonial legacies of racism; land dispossession; and the suppression of Indigenous cultures, languages, and knowledges have had profound impacts. For example, although Indigenous Peoples make up just 6% of the global population, they account for about 20% of the world’s extreme poor. Despite this, Indigenous Peoples continue to assert their sovereignty and to uphold their responsibilities as protectors and stewards of their lands, waters, and knowledges.

The rest of the article is here.

Here is a brief summary:

This is an article about Indigenous data sovereignty. It discusses the importance of Indigenous communities having control over their own data. This is because data can be used to exploit and harm Indigenous communities. Indigenous data sovereignty is a way for Indigenous communities to protect themselves from this harm. There are a number of principles that guide Indigenous data sovereignty, including collective consent and the importance of upholding cultural protocols. Indigenous data sovereignty is still in its early stages, but it has the potential to be a powerful tool for Indigenous communities.

Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients

Soim Park, Johannes Thrul, et al. (2023)

Journal of Trauma & Dissociation

DOI: 10.1080/15299732.2023.2289195

Abstract

One factor potentially driving healthcare and hospital worker (HHW)’s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others’ pandemic-related responses and behaviors. We investigated whether HHWs’ betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

Here is my take for psychologists:

The article identifies betrayal-based moral injury as a significant factor contributing to mental health problems among healthcare workers during the COVID-19 pandemic. The research demonstrates a strong association between feelings of betrayal and both mental distress and PTSD symptoms. This suggests that interventions aimed at addressing betrayal-based moral injury could play a crucial role in improving the mental well-being of healthcare workers.

The article provides valuable insights into specific sources of betrayal experienced by healthcare workers. The study highlights that betrayal can stem from institutional leaders, coworkers, and even individuals outside of the healthcare system. This understanding can inform targeted interventions aimed at rebuilding trust and repairing ruptures within healthcare institutions and the broader community.

By understanding the impact of betrayal-based moral injury and its sources, clinical psychologists can develop more effective interventions to support healthcare workers' mental health. These efforts can improve the well-being of individuals working on the frontlines, potentially leading to better patient care and a more sustainable healthcare system.

Human-Algorithm Interactions Help Explain the Spread of Misinformation

McLoughlin, K. L., & Brady, W. J. (2023).

Current Opinion in Psychology, 101770.

https://doi.org/10.1016/j.copsyc.2023.101770

Abstract

Human attention biases toward moral and emotional information are as prevalent online as they are offline. When these biases interact with content algorithms that curate social media users’ news feeds to maximize attentional capture, moral and emotional information are privileged in the online information ecosystem. We review evidence for these human-algorithm interactions and argue that misinformation exploits this process to spread online. This framework suggests that interventions aimed at combating misinformation require a dual-pronged approach that combines person-centered and design-centered interventions to be most effective. We suggest several avenues for research in the psychological study of misinformation sharing under a framework of human-algorithm interaction.

Here is my summary:

This research highlights the crucial role of human-algorithm interactions in driving the spread of misinformation online. It argues that both human attentional biases and algorithmic amplification mechanisms contribute to this phenomenon.

Firstly, humans naturally gravitate towards information that evokes moral and emotional responses. This inherent bias makes us more susceptible to engaging with and sharing misinformation that leverages these emotions, such as outrage, fear, or anger.

Secondly, social media algorithms are designed to maximize user engagement, which often translates to prioritizing content that triggers strong emotions. This creates a feedback loop where emotionally charged misinformation is amplified, further attracting human attention and fueling its spread.

The research concludes that effectively combating misinformation requires a multifaceted approach. It emphasizes the need for interventions that address both human psychology and algorithmic design. This includes promoting media literacy, encouraging critical thinking skills, and designing algorithms that prioritize factual accuracy and diverse perspectives over emotional engagement.

The power of social influence: A replication and extension of the Asch experiment

Franzen A, Mader S (2023)

PLoS ONE 18(11): e0294325.

https://doi.org/10.1371/journal.pone.0294325

Abstract

In this paper, we pursue four goals: First, we replicate the original Asch experiment with five confederates and one naïve subject in each group (N = 210). Second, in a randomized trial we incentivize the decisions in the line experiment and demonstrate that monetary incentives lower the error rate, but that social influence is still at work. Third, we confront subjects with different political statements and show that the power of social influence can be generalized to matters of political opinion. Finally, we investigate whether intelligence, self-esteem, the need for social approval, and the Big Five are related to the susceptibility to provide conforming answers. We find an error rate of 33% for the standard length-of-line experiment which replicates the original findings by Asch (1951, 1955, 1956). Furthermore, in the incentivized condition the error rate decreases to 25%. For political opinions we find a conformity rate of 38%. However, besides openness, none of the investigated personality traits are convincingly related to the susceptibility of group pressure.

My summary:

This research aimed to replicate and extend the classic Asch conformity experiment, investigating the extent to which individuals conform to group pressure in a line-judging task. The study involved 210 participants divided into groups, with one naive participant and five confederates who provided deliberately incorrect answers. Replicating the original findings, the researchers observed an average error rate of 33%, demonstrating the enduring power of social influence in shaping individual judgments.

Furthering the investigation, the study explored the impact of monetary incentives on conformity. The researchers found that offering rewards for independent judgments reduced the error rate, suggesting that individuals are more likely to resist social pressure when motivated by personal gain. However, the study still observed a significant level of conformity even with incentives, indicating that social influence remains a powerful force even when competing with personal interests.

Worth the Risk? Greater Acceptance of Instrumental Harm Befalling Men than Women

Graso, M., Reynolds, T. & Aquino, K.

Arch Sex Behav 52, 2433–2445 (2023).

https://doi.org/10.1007/s10508-023-02571-0

Abstract

Scientific and organizational interventions often involve trade-offs whereby they benefit some but entail costs to others (i.e., instrumental harm; IH). We hypothesized that the gender of the persons incurring those costs would influence intervention endorsement, such that people would more readily support interventions inflicting IH onto men than onto women. We also hypothesized that women would exhibit greater asymmetries in their acceptance of IH to men versus women. Three experimental studies (two pre-registered) tested these hypotheses. Studies 1 and 2 granted support for these predictions using a variety of interventions and contexts. Study 3 tested a possible boundary condition of these asymmetries using contexts in which women have traditionally been expected to sacrifice more than men: caring for infants, children, the elderly, and the ill. Even in these traditionally female contexts, participants still more readily accepted IH to men than women. Findings indicate people (especially women) are less willing to accept instrumental harm befalling women (vs. men). We discuss the theoretical and practical implications and limitations of our findings.

Here is my summary:

This research investigated the societal acceptance of "instrumental harm" (IH) based on the gender of the person experiencing it. Three studies found that people are more likely to tolerate IH when it happens to men than when it happens to women. This bias is especially pronounced among women and those holding egalitarian or feminist beliefs. Even in contexts traditionally associated with women's vulnerability, IH inflicted on men is seen as more acceptable.

These findings highlight a potential blind spot in our perception of harm and raise concerns about how policies might be influenced by this bias. Further research is needed to understand the underlying reasons for this bias and develop strategies to address it.