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
Showing posts with label Evidence Based Practice. Show all posts
Showing posts with label Evidence Based Practice. Show all posts

Friday, December 11, 2020

11th Circuit blocks South FL prohibitions on 'conversion therapy' for minors as unconstitutional

Michael Moline
Florida Pheonix
Originally posted 20 Nov 20

Here is an excerpt:

“We understand and appreciate that the therapy is highly controversial. But the First Amendment has no carve-out for controversial speech. We hold that the challenged ordinances violate the First Amendment because they are content-based regulations of speech that cannot survive strict scrutiny,” Grant wrote.

Judge Beverly Martin dissented, pointing to condemnations of the practice by the American Academy of Pediatrics, the American Psychiatric Association, the American Psychological Association, the American Psychoanalytic Association, the American Academy of Child and Adolescent Psychiatry, the American School Counselor Association, the U.S. Department of Health and Human Services, and the World Health Organization.

“Today’s majority opinion puts a stop to municipal efforts to regulate ‘sexual orientation change efforts’ (commonly known as ‘conversion therapy’), which is known to be a harmful therapeutic practice,” Martin wrote.

“The majority invalidates laws enacted to curb these therapeutic practices, despite strong evidence of the harm they cause, as well as the laws’ narrow focus on licensed therapists practicing on patients who are minors. Although I am mindful of the free-speech concerns the majority expresses, I respectfully dissent from the decision to enjoin these laws.”

Matt Staver, founder and chairman of Liberty Counsel, the conservative legal organization that represented two counselors who challenged the ordinance, welcomed the ruling.

“This is a huge victory for counselors and their clients to choose the counsel of their choice free of political censorship from government ideologues. This case is the beginning of the end of similar unconstitutional counseling bans around the country,” he said in a written statement.

Friday, February 16, 2018

The Scientism of Psychiatry

Sami Timimi
Mad in America
Originally posted January 10, 2018

Here is an excerpt:

Mainstream psychiatry has been afflicted by at least two types of scientism. Firstly, it parodies science as ideology, liking to talk in scientific language, using the language of EBM, and carrying out research that ‘looks’ scientific (such as brain scanning). Psychiatry wants to be seen as residing in the same scientific cosmology as the rest of medicine. Yet the cupboard of actual clinically relevant findings remains pretty empty. Secondly, it ignores much of the genuine science there is and goes on supporting and perpetuating concepts and treatments that have little scientific support. This is a more harmful and deceptive form of scientism; it means that psychiatry likes to talk in the language of science and treats this as more important than the actual science.

I have had debates with fellow psychiatrists on many aspects of the actual evidence base. Two ‘defences’ have become familiar to me. The first is use of anecdote — such and such a patient got better with such and such a treatment, therefore, this treatment ‘works.’ Anecdote is precisely what EBM was trying to get away from. The second is an appeal for me to take a ‘balanced’ perspective. Of course each person’s idea of what is a ‘balanced’ position depends on where they are sitting. We get our ideas on what is ‘balanced’ from what is culturally dominant, not from what the science is telling us. At one point, to many people, Nelson Mandala was a violent terrorist; later to many more people, he becomes the embodiment of peaceful reconciliation and forgiveness. What were considered ‘balanced’ views on him were almost polar opposites, depending on where and when you were examining him from. Furthermore, in science facts are simply that. Our interpretations are of course based on our reading of these facts. Providing an interpretation consistent with the facts is more important than any one person’s notion of what a ‘balanced’ position should look like.

The article is here.

Thursday, February 1, 2018

How to Counter the Circus of Pseudoscience

Lisa Pryor
The New York Times
Originally published January 5, 2018

Here are two excerpts:

In the face of such doubt, it is not surprising that some individuals, even those who are intelligent and well educated, are swept away by the breezy confidence of health gurus, who are full of passionate intensity while the qualified lack all conviction, to borrow from Yeats.

It is a cognitive bias known in psychology as the Dunning-Kruger Effect. In short, the less you know, the less able you are to recognize how little you know, so the less likely you are to recognize your errors and shortcomings. For the highly skilled, like trained scientists, the opposite is true: The more you know, the more likely you are to see how little you know. This is truly a cognitive bias for our time.


Engaging is difficult when the alternative-health proponents are on such a different astral plane that it is a challenge even to find common language for a conversation, especially when they promote spurious concepts such as “pyrrole disease,” which they can speak about in great, false detail, drawing the well-informed physician, dietitian or scientist into a vortex of personal anecdote and ancient wisdom, with quips about big pharma thrown in for good measure.

The information is here.

Wednesday, March 22, 2017

The Case of Dr. Oz: Ethics, Evidence, and Does Professional Self-Regulation Work?

Jon C. Tilburt, Megan Allyse, and Frederic W. Hafferty
AMA Journal of Ethics. February 2017, Volume 19, Number 2: 199-206.


Dr. Mehmet Oz is widely known not just as a successful media personality donning the title “America’s Doctor®,” but, we suggest, also as a physician visibly out of step with his profession. A recent, unsuccessful attempt to censure Dr. Oz raises the issue of whether the medical profession can effectively self-regulate at all. It also raises concern that the medical profession’s self-regulation might be selectively activated, perhaps only when the subject of professional censure has achieved a level of public visibility. We argue here that the medical profession must look at itself with a healthy dose of self-doubt about whether it has sufficient knowledge of or handle on the less visible Dr. “Ozes” quietly operating under the profession’s presumptive endorsement.

The article is here.

Saturday, September 3, 2016

Evidence-Based Practice and Psychological Treatments: The Imperatives of Informed Consent.

Charlotte R. Blease, Scott O. Lilienfeld and John M. Kelley
Front. Psychol., 10 August 2016

Here is an excerpt:

Professional competence—the ability to accurately assess problems, diagnose psychological disorders, recommend an appropriate course of treatment, and successfully carry out that treatment—varies depending on the degree to which the clinician keeps up to date with the latest research and effectively evaluates the evidence. The APA requires that clinicians be trained in EBP to be equipped to appraise the range of evidence regarding the efficacy of different forms of psychotherapy, to recognize the strengths and limitations of clinical intuition, and to understand the importance of patient preferences and values, as well as the relevance of the socio-cultural context in treating clients. In this way, the APA acknowledges that EBP requires knowledge of controlled clinical trials, but also underlines that trial data have inherent limitations. For example, such trials can be unrepresentative of individual patients given that they can be largely insensitive to such factors as age of patient, and comorbidity [American Psychological Association (APA), 2006; cf. Greenhalgh et al., 2014; Sheridan and Julian, 2016]. The APA also emphasizes the importance of keeping up to date with the latest process—and not merely outcome—data on how psychotherapies work [American Psychological Association (APA), 2006].

The duty to be professionally competent carries significant additional implications for the duty to respect patient autonomy. Historically, paternalism was the largely unquestioned bedrock of healthcare practice. Paternalism is defined as “the interference of a state or an individual by another person, against their will, and defended or motivated by the claim that the person interfered with will be better off or protected from harm” (Dworkin, 2010); it was defended on the grounds that doctors were the gatekeepers of medical knowledge, as well as the best judges of how to use that knowledge to serve the interests of patients. Today, healthcare ethics codes (in the West) eschew paternalism: professional clinicians are now obliged to be truthful and to provide adequate disclosure to patients about their diagnosis, the risks and benefits of various treatment options, and their duration and costs (Trachsel et al., 2015; Blease et al., 2016; Trachsel and Gaab, 2016). However, the quality of disclosures to patients depends on practitioner knowledge, illustrating once again why standards of evidence are enmeshed with ethics.

The article is here.

Monday, May 18, 2015

Why Many Doctors Don't Follow 'Best Practices'

By Anders Kelto
NPR News - All Things Considered
Originally published April 22, 2015

Here is an excerpt:

Imagine, for example, that a healthy, 40-year-old woman walks into your office and asks about a mammogram.

"If that woman were to develop breast cancer or to have breast cancer, you can imagine what might happen to you if you didn't order the test," Wu says. "Maybe you'd get sued."

Doctors often hear stories like this, he says, and that can affect their judgment.

"Emotion and recent events do influence our decision-making," he says. "We are not absolutely rational, decision-making machines."

The entire article is here.

Thursday, January 23, 2014

Evidence based medicine is broken

By Des Spence
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g22 (Published 3 January 2014)
Cite this as: BMJ 2014;348:g22

Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.

The entire article is here.

Friday, December 13, 2013

The Critical Role of School Climate in Effective Bullying Prevention

By Cixin Wanga, Brandi Berryb & Susan M. Swearerc
Theory Into Practice
Volume 52, Issue 4, 2013


Research has shown a negative association between positive school climate and bullying behavior. This article reviews research on school climate and bullying behavior and proposes that an unhealthy and unsupportive school climate (e.g., negative relationship between teachers and students, positive attitudes towards bullying) provides a social context that allows bullying behavior to occur. We provide information on how to evaluate the school climate and intervene to promote a more positive school climate and to reduce bullying behavior. Although there has been an increased interest among school personnel, parents, and students to reduce bullying behavior, the issue of how to assess the myriad of factors that may cause and maintain bullying behaviors, and to select evidence-based prevention and intervention programs, remains a challenge for many educators. This article seeks to address these two issues by highlighting the importance of school climate in bullying prevention and reviewing some school climate evaluations and intervention programs.

The entire article is here.

Thursday, December 12, 2013

Doctors who call patients hypochondriacs are committing malpractice

By Zackary Berger
Originally posted on November 25, 2013

There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”

First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them out. I firmly believe that no complaint is illegitimate.

The entire blog post is here.

Thanks to Ed Zuckerman for this information.

Monday, November 25, 2013

Bamboozled by Bad Science

The first myth about "evidence-based" therapy

Published on October 31, 2013 by Jonathan Shedler, PhD in Psychologically Minded

Media coverage of psychotherapy often advises people to seek "evidence-based therapy."
Few outside the mental health professions realize the term “evidence-based therapy” is a form of branding. It refers to therapies conducted by following instruction manuals, originally developed to create standardized treatments for research trials. These "manualized" therapies are typically brief, highly structured, and almost exclusively identified with cognitive behavioral therapy or CBT.

Academic researchers routinely extoll the “evidence-based” therapies studied in research laboratories and denigrate psychotherapy as it is actually practiced by most clinicians in the real world. Their comments range from the hysteric (“The disconnect between what clinicians do and what science has discovered is an unconscionable embarrassment.”–Professor Walter Mischel, quoted in Newsweek) to the seemingly cautious and sober (“Evidence-based therapies work a little faster, a little better, and for more problematic situations, more powerfully.”–Professor Steven Hollon, quoted in the Los Angeles Times).

The entire blog post is here.

Friday, July 12, 2013

Diagnosis: Insufficient Outrage

The New York Times - Op Ed
Published: July 4, 2013

RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?

I’m not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although crime in that sense definitely exists. I’m talking instead about the violation of an ethical standard, of the very “calling” of medicine.

Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting.

A number of publications — including this one — have recently published big reports on the exorbitant cost of American health care. In March, Time magazine ran a cover story exposing outrageous hospital prices, from $108 for a tube of bacitracin — the ointment my mother put on the scrapes I got as a kid and that costs $5 at CVS — to $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.

The entire story is here.

Thursday, May 9, 2013

Most Docs Don't Follow ADHD Treatment Guidelines for Preschoolers: Study

By Robert Preidt
Originally published on May 4, 2013

About 90 percent of pediatric specialists who diagnose and manage attention-deficit/hyperactivity disorder (ADHD) in preschool children do not follow treatment guidelines published recently by the American Academy of Pediatrics, according to a new study.

Some prescribe medications too soon, while others do not give the young patients drugs even as a second-line treatment, according to study author Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., and colleagues.

The American Academy of Pediatrics (AAP) guidelines recommend that behavior therapy be the first treatment approach for preschoolers with ADHD, and that treatment with medication should be used only when behavior-management counseling is unsuccessful.  (Emphasis added)

The entire story is here.

Click here to review the guidelines.

A similar story can be found in Time.

Friday, March 29, 2013

Kaiser Permanente cited for EHR mental health violations

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

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

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

The entire story is here.

Thanks to Ed Zuckerman for this story.

Wednesday, December 26, 2012

DSM-5 Could Be Hazardous to Your Mental Health

By Elayne Clift
Originally published on December 22, 2012

Here are some excerpts:

Feminist therapists are concerned for women in particular. Diagnoses such as Borderline Personality Disorder (BPD) and Sexual Dysfunction have disparaged women and compromised them in troubling ways. For example, one expert says that BPD is almost exclusively applied to women because its symptoms relate to emotion and anger.   Some women with the diagnosis have histories of abuse and may have difficulty expressing anger "appropriately."   Such vulnerable women need to have their coping styles better understood before assumptions are made about their behavior.

Similarly, "sexual dysfunction" among women is often based on assumptions about what constitutes normal sexual behavior.   "If only performance failures or lack of desire count, the entire context of sexual activity becomes invisible and of secondary importance," says one member of the Association of Women in Psychology (AWP).

Another AWP member focuses on classism in psychiatric diagnosis.   "Poor women and women of color are particularly likely to be misdiagnosed or encounter bias in treatment," she says. "Therapists may interpret chronic lateness or missed appointments as hostility or resistance to treatment rather than the outcomes of unreliable transportation, irregular shift work, and unpredictable child care arrangements."

The entire article is here.

Saturday, July 7, 2012

Psychiatry's identity crisis - A Response

The Lancet, Volume 379, Issue 9835, Page 2428, 30 June 2012
By Andres Barkil-Oteo

Psychiatry has attempted to cope with its identity problem (April 7, p 1274) mainly by assuming an evidence-based approach, favoured throughout medicine. Evidence-based, however, became largely synonymous with psychopharmacological approaches, with relative disregard for other evidence-based modalities.

This situation has created a dilemma since the evidence for many common medication-prescribing practices is being challenged, whereas many of the psychological approaches have very solid evidence but are underused (eg, family psychoeducation). A good example is the extensive use of second-generation antipsychotic drugs, despite evidence of their lack of superiority over first-generation medication, as well as additional economic cost and the added burden of medical complications.

The entire response is here.