Social Networking’s ‘Big Impact’ on Medicine

Eric Topol, MD
MedScape Today: The Creative Destruction of Medicine
Originally posted July 17, 2012

Here are some excerpts:

Everybody is familiar with Facebook, which soon will have 1 billion registrants and be second only to China and India as far as a community or population. What isn't so much appreciated by the medical community is that our patients are turning to online health social networking. These are such Websites as PatientsLikeMe, CureTogether, and many others.

Interestingly, patients with like conditions -- often chronic conditions, such as multiple sclerosis, diabetes, or amyotrophic lateral sclerosis (ALS) -- will find patients with the same condition on these networking sites. And these virtual peers will become very much a key guidance source. This is so different from the past, when all information emanated from physicians. In fact, now many of these individuals who use social networks trust their virtual peers more than their physicians, so this is a real change that's taken place. In addition to this, the social networking platforms, which are free, offer an opportunity we haven't seen before.

The entire text and video are here.

NJ school district moves to fire teacher who made anti-gay Facebook comments

By Star Ledger Staff

 

It was three months ago when anti-gay comments posted on Facebook by a Union High School teacher caused a nationwide controversy. Now, those comments may cost the instructor her job.

The Union Township school board announced today it has filed tenure charges against Viki Knox, the longtime teacher and faculty adviser to the high school’s Bible study group.

Board president Francis R. Perkins said the charges were formally filed in late December after a three-month investigation of Knox’s conduct, the first step in what could be a lengthy and costly process to fire her.

"Every student, no matter what race, creed color or sexual orientation ought to be able to come to school and feel comfortable in a learning environment that’s welcoming and nurturing," Perkins said.

Knox, 50, who has been on paid administrative leave, could not be reached. Sandy Oxfeld, Knox’s attorney, said he would have no comment on the case while it is in litigation.

The move by the Union school board has rekindled a broader issue of free-speech rights of teachers in the growing age of social media.

The entire story is here.

Facebook aims to help prevent suicide

By BROOKE DONALD
The Associated Press

A program launching Tuesday (December 13, 2011) enables users to instantly connect with a crisis counselor through Facebook's "chat" messaging system.

The service is the latest tool from Facebook aimed at improving safety on its site, which has more than 800 million users. Earlier this year, Facebook announced changes to how users report bullying, offensive content and fake profiles.

"One of the big goals here is to get the person in distress into the right help as soon as possible," Fred Wolens, public policy manager at Facebook, told The Associated Press.
Google and Yahoo have long provided the phone number to the National Suicide Prevention Lifeline as the first result when someone searches for "suicide" using their sites. Through email, Facebook also directed users to the hotline or encouraged friends to call law enforcement if they perceived someone was about to do harm.

The new service goes a step further by enabling an instant chat session that experts say can make all the difference with someone seeking help.

"The science shows that people experience reductions in suicidal thinking when there is quick intervention," said Lidia Bernik, associate project director of Lifeline. "We've heard from many people who say they want to talk to someone but don't want to call. Instant message is perfect for that."

How the service works is if a friend spots a suicidal thought on someone's page, he can report it to Facebook by clicking a link next to the comment. Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat.

Facebook on its own doesn't troll the site for suicidal expressions, Wolens said. Logistically it would be far too difficult with so many users and so many comments that could be misinterpreted by a computer algorithm.

"The only people who will have a really good idea of what's going on is your friends so we're encouraging them to speak up and giving them an easy and quick way to get help," Wolens said.

The entire story can be found here.

Facebook refuses to shut rape page run by schoolboy

theage.com.au
By Philip Sherwell in New York

Nobody knows better than MJ Stephens that rape is no laughing matter. So as the victim of a sexual assault, she was horrified when she encountered the contents of a Facebook page full of jokes about rape and violence towards women.

But worse was to come when the young American tried to argue with people who had attached comments to a page called: "You know shes [sic] playing hard to get when your [sic] chasing her down an alleyway" - most of them teenagers and young adults from Australia and Britain.

In sickeningly explicit terms, several of them threatened her and expressed the wish that she be raped again.

Such pages, full of ugliness, aggression and pornographic language are multiplying on Facebook, drawing lucrative user traffic to the social networking site.

Now it has emerged that one of the "administrators" of the page - users with the right to edit its content - is believed to be a British schoolboy linked to a network of hackers in Australia, Britain and America who have set up Facebook pages featuring offensive sexual and violent content.

Micheal O'Brien, a Canadian computer systems engineer who co-founded the Rape Is No Joke (RINJ) campaign to pressure Facebook to delete "rape pages" via petitions and boycotts, has tracked the activity on several such pages and contacted participants online.

He told London's The Sunday Telegraph that associates of 4chan, a loose-knit collection of international "cyber-anarchists" who champion absolute online freedom, including the right to share pornography, have founded and administer several of the pages.

 

The entire story can be found here.

Thanks to Gary Schoener for the link to this article.

Angela Dean: Winner of the Patricia M. Bricklin Award

The PPA Ethics Committee presents the annual Patricia M. Bricklin Award to a Pennsylvania graduate student who submits the best work product (such as a paper) on ethics.  This year, Angela Dean, a student at Catham University earned the award.  Her professor is Anthony Goreczny, Ph.D.

The award comes with $500 that is funded by the Pennsylvania Psychological Foundation. 

The Ethics Committee invited Ms. Dean to our annual Ethics Educator Conference to be held in October, 2011.  Additionally, Ms. Dean will have a version of her paper published in The Pennsylvania Psychologist.


The title of the paper is Facebook for Psychologists: "Friend"ship Ethics.  It can be reviewed or downloaded from docstoc (below).


FB_Psychological_Ethics -

Harvard Researchers Accused of Breaching Students' Privacy

Social-network project shows promise and peril of doing social science online

By Marc Parry
Chronicle of Higher Education

In 2006, Harvard sociologists struck a mother lode of social-science data, offering a new way to answer big questions about how race and cultural tastes affect relationships.

The source: some 1,700 Facebook profiles, downloaded from an entire class of students at an "anonymous" university, that could reveal how friendships and interests evolve over time.

It was the kind of collection that hundreds of scholars would find interesting. And in 2008, the Harvard team began to realize that potential by publicly releasing part of its archive.

But today the data-sharing venture has collapsed. The Facebook archive is more like plutonium than gold—its contents yanked offline, its future release uncertain, its creators scolded by some scholars for downloading the profiles without students' knowledge and for failing to protect their privacy. Those students have been identified as Harvard College's Class of 2009.

The story of that collapse shines a light on emerging ethical challenges faced by scholars researching social networks and other online environments.

The Harvard sociologists argue that the data pulled from students' Facebook profiles could lead to great scientific benefits, and that substantial efforts have been made to protect the students. Jason Kaufman, the project's principal investigator and a research fellow at Harvard's Berkman Center for Internet & Society, points out that data were redacted to minimize the risk of identification. No student seems to have suffered any harm. Mr. Kaufman accuses his critics of acting like "academic paparazzi."

Adding to the complications, researchers like Mr. Kaufman are being asked to safeguard privacy in an era when grant-making agencies increasingly request that data be shared—as the National Science Foundation did as a condition for backing Harvard's Facebook study.

The Facebook project began to unravel in 2008, when a privacy scholar at the University of Wisconsin at Milwaukee, Michael Zimmer, showed that the "anonymous" data of Mr. Kaufman and his colleagues could be cracked to identify the source as Harvard undergraduates.

The entire story can be read here.

Facebook friend request from a patient?

The Lancet, Volume 377, Issue 9772, Pages 1141 - 1142, 2 April 2011

doi:10.1016/S0140-6736(11)60449-2

Sharmila Devi

Widespread use of new technologies such as social networking sites are creating ethical problems for physicians that some doctors' organisations are beginning to address. Sharmila Devi reports.

Social networking sites such as Facebook and the ubiquity of search engines such as Google are creating new medical ethical dilemmas as physicians around the world grapple with how to responsibly include new technologies in their professional lives.

In the USA, birthplace of most of these technological advances, various associations of health-care professionals are starting to issue codes of conduct when dealing with new digital media. Other countries, such as the UK, Canada, and Australia, are also debating what rules should be set. But some doctors believe such codes will have to evolve and adapt as younger generations, used to living an online life from an early age, start to dominate health care and to teach subsequent waves of professionals.

Websites such as Facebook allow individuals to post messages, photos, and videos and share them with an online group of friends. They can also be used to reach out professionally to a wider range of people than was possible with some traditional marketing methods. But used unwisely, such sites can blur the lines between the personal and professional and cause embarrassment.

“Older generations will moralise and say it's unethical and unprofessional [to be friends with clients on sites such as Facebook]”, says Ofer Zur, an Israeli psychologist based in California, USA, who offers online courses in digital medical ethics. “Younger generations have less of a sense of hierarchy and see the internet as an equaliser that opens doors. I am typical of the older generation because I sometimes cringe at the things my daughter posts online.”

Although it would seem obvious for many professionals to maintain as strict a boundary between them and clients in the online world as in the physical world, Zur said online interactions should be looked at on a case-by-case basis. For example, a physician in a small community might find that Facebook simply replicated the flow of information that already took place amid existing close relationships, he says.

Cases where health-care professionals have taken things too far are rare but well publicised. In February, a physician assistant working at a medical centre in New York state was found to have posted photos on Facebook showing him holding a syringe at a man's neck. He said: “When you can't start a line in a junkie's arm…go for the neck”, reported The Journal News, a local newspaper.

Such behaviour is unanimously condemned as inappropriate. More difficult to answer are questions such as whether health-care professionals should be allowed to research a client's background on the search engine Google? Does a blog's informative value outweigh any possible breach of confidentiality? Should medical students post online any personal information about themselves for fear of jeopardising relations with future clients and employers? “Questions about the internet are becoming a common inquiry among our members who want to take advantage of it, especially younger members and students, and the number one concern is confidentiality and how to preserve it”, says Erin Martz, manager of ethics and professional standards at the American Counselling Association. “We actually just received our first ethical complaint that's Facebook-connected and technically-driven. I do think Facebook can be quite dangerous.”

The rest of the article is here and can be accessed through psycnet.apa.org/psycinfo with your APA log in.

Ethics Opinion Tackles 'Friend' Requests

This article is about the ethics for lawyers.  Simultaneously, it is an interesting read about how professionals are trying to use social networking sites to their advantage.

          *          *          *          * 
by Cynthia Foster

The Recorder

Enterprising lawyers beware: using Facebook as an investigative tool may get you into trouble with the bar, says an ethics opinion from the San Diego County Bar Association.

The opinion concludes that sending a Facebook "friend request" to a represented party violates California Rule of Professional Conduct 2-100 and could be cause for discipline. The opinion's author, Daniel Eaton, said it's the first to confront ex parte communication through social media.

Eaton, an employment defense partner at Seltzer Caplan McMahon Vitek in San Diego, said the bar association's ethics committee considered whether lawyers could approach Facebook the way they approach the wider, public Internet — checking a company's website for information related to a matter, for instance.

"Lawyers are making very wide use of social media, and we wanted to test the proposition that lawyers could use social media to reach out to parties that are represented. Is that a legitimate form of the kind of broad investigation that lawyers engage in using the Internet?" Eaton said.

He didn't think so. But other members of the ethics committee, including its co-chair, San Diego County Deputy District Attorney Wendy Patrick, were dubious.

"When you just hear the proposition it kind of takes you aback, because how could a friend request concern the subject matter of representation? It doesn't appear on its face to violate the rule," she said.

Patrick, who is also vice chair of the State Bar's Committee on Professional Responsibility and Conduct, said she was won over to Eaton's position after reading his research. The rest of the committee was, too. The opinion, which Eaton said was the lengthiest he could remember the committee ever voting on, passed unanimously in May and was approved by the association's board last week.

The opinion is not binding in state court, but according to CRPC Rule 1-100 should be used by attorneys as a behavioral guide. Eaton said the committee was surprised to find that no other associations had directly addressed the link between social media communication and ex parte communication.

According to the opinion, lawyers who try to friend opposing parties as an investigative tool are attempting to deceive them.

"And who needs friends like that?" said Patrick.

The Internet's Ethical Challenges

A common theme on this blog is the nexus of psychology and ethics on the internet.  The capacity to communicate, interact and build relationships at a distance is becoming increasingly easy and affordable.  From a number of discussions with college students, some individuals actually prefer texting and skyping to outdated emailing and talking on the phone.

Psychologists will continue to venture into telepsychology and building relationships over the internet.  As clinical practice continues to move into this brave new world, psychologists need to consider the ethical implications of new technologies with their work as well as their personal lives.

Sara Martin from the APA's Monitor wrote a story entitled The Internet's Ethical Challenges.  A portion of the article is listed below.  The information just begins to scratch the surface of ethical issues related to a psychologist's presence on the internet.

-----------------------------

Should you Google your clients?

Should you ‘friend’ a student on Facebook?

APA’s Ethics Director Stephen Behnke answers those questions and more.

No form of client communication is 100 percent guaranteed to be private. Conversations can be overheard, e-mails can be sent to the wrong recipients and phone conversation can be listened to by others.

But in today’s age of e-mail, Facebook, Twitter and other social media, psychologists have to be more aware than ever of the ethical pitfalls they can fall into by using these types of communication.

“It’s easy not to be fully mindful about the possibility of disclosure with these communications because we use these technologies so often in our social lives,” says Stephen Behnke, PhD, JD, director of APA’s Ethics Office. “It’s something that we haven’t gotten into the habit of thinking about.”


Stephen Benhke


The Monitor sat down with Behnke to discuss the ethical aspects of the Internet for psychology practitioners and how to think about them.

Does the APA Ethics Code guide practitioners on social media?

Yes. The current Ethics Code was drafted between 1997 and 2002. While it doesn’t use the terms “social media,” “Google” or “Facebook,” the code is very clear that it applies to all psychologists’ professional activities and to electronic communication, which of course social media is.



As we look at the Ethics Code, the sections that are particularly relevant to social media are on privacy and confidentiality, multiple relationships and the section on therapy. The Ethics Code does not prohibit all social relationships, but it does call on psychologists to ask, “How does this particular relationship fit with the treatment relationship?”

Is the APA Ethics Office seeing any particular problems in the use of social media?



Everyone is communicating with these new technologies, but our ethical obligation is to be thoughtful about how the Ethics Code applies to these communications and how the laws and regulations apply.

For example, if you are communicating with your client via e-mail or text messaging, those communications might be considered part of your client’s record. Also, you want to consider who else might have access to the communication, something the client him- or herself may not be fully mindful of. When you communicate with clients, the communication may be kept on a server so anyone with access to that server may have access to your communications. Confidentiality should be front and center in your thinking.



Also, consider the form of communication you are using, given the kind of treatment you are providing. For example, there are two very different scenarios from a clinical perspective: In one scenario, you’ve been working with a client face-to-face and you know the client’s clinical issues. Then the client goes away on vacation and you have one or two phone sessions, or a session or two on Skype. A very different scenario is that the psychologist treats a client online, a client he or she has never met or seen. In this case, the psychologist has to be very mindful of the kind of treatment he or she can provide. What sorts of issues are appropriate to treat in that manner? How do the relevant jurisdiction’s laws and regulations apply to the work you are doing?

That’s an example of how the technology is out in front of us. We have this wonderful new technology that allows us to offer services to folks who may never have had access to a psychologist. At the same time, the ethical, legal and regulatory infrastructure to support the technology is not yet in place. A good deal of thought and care must go into how we use the technology, given how it may affect our clients and what it means for our professional lives.



APA needs to be involved in developing that ethical, legal and regulatory infrastructure and needs to be front and center on this.

What do you want members to know about using Facebook?

People are generally aware that what they put on their Facebook pages may be publicly accessible. Even with privacy settings, there are ways that people can get access to your information.



My recommendation is to educate yourself about privacy settings and how you can make your page as private as you want it to be. Also, educate yourself about how the technology works and be mindful of the information you make available about yourself. Historically, psychology has talked a lot about the clinical implications of self-disclosure, but this is several orders of magnitude greater, because now anyone sitting in their home or library with access to a terminal can find out an enormous amount of information about you.

Facebook is a wonderful way to social network, to be part of a community. And of course psychologists are going to use this, as is every segment of the population. But psychologists have special ethical issues they need to think through to determine how this technology is going to affect their work.

To Friend or Not to Friend: That is the Question

Anthony S. Ragusea, Psy.D.

Florida Psychological Association

Guest Blog 


Recently on the Florida Psychological Association (FPA) listserv there was a spirited debate about whether or not it is professionally appropriate to accept a “Friend” request on Facebook by a client.  The fact that the debate was happening at all speaks to the enormous change that the Internet and a private social media company, Facebook, is having on the practice of psychology.  For the uninitiated, Facebook provides a space, much like any personal web page, where one can post pictures, text, links to other sites, and share all that personal information with a select group of “Friends.” Friends are other users of Facebook who are invited by you to see everything you’ve posted on your page, engage in conversations with you, and otherwise interact with you.  One can also create professional pages, but most users prefer personal profiles.

Facebook has over 500 million users worldwide, so the chances are good that some of your clients have Facebook pages.  In fact, as the debate on the FPA listserv suggests, many psychologists who use Facebook have encountered situations where clients have asked to become Friends of their psychologist.  Whether or not to accept such a request is a complicated decision, depending on one’s level of comfort with dual relationships, whether the dual relationship is unethical, the theoretical orientation of the psychologist, the risk management practices of the psychologist, the unique circumstances of the request, and perhaps other factors as well. 

In other words, there are legal, ethical, professional, and personal factors to consider.  Each of these general factors is separate from the others.  For example, a psychologist may be personally comfortable with having a client as a Friend, but from a psychoanalytic orientation may have concerns about what that relationship may have on the development of transference in therapy.  Or, a humanistic psychologist may feel that to draw a relationship boundary with a client over Facebook would be a sign of disrespect, a way of creating a hierarchical relationship with the client that suggests “you must be self-disclosing with me, but I will not disclose myself with you,” yet may still choose not to accept a client as a Friend because of concerns that the relationship may increase the chances of the client filing a complaint against the psychologist or terminating therapy.  Several articles have been written recently about managing such concerns on Facebook, Google, and the Internet in general.  A very good one about Facebook was written by psychologist Ofer Zur (2011), and the full text is available on his website.  I will briefly address the ethical dilemma with current clients here. 

As always, when deciding whether a professional behavior is ethical or not, we look first to the APA’s Ethical Principles of Psychologists and Code of Conduct.  The most relevant standard relates to Multiple Relationships (3.05).  This standard reads in part:

“A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

 Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.”

This standard informs us that to “friend” a client is not inherently unethical, because a Facebook relationship is not intrinsically harmful and may not impair the psychologist’s effectiveness in the professional relationship.  It is up to the psychologist to predict whether harm may come to the client or to the professional relationship.  Some conceivable harms could include: the client learns personal information about the psychologist which causes the client to dislike the psychologist; the client develops an unhealthy fantasy about the psychologist as a result of this window into the psychologist’s life; the psychologist comes to view the relationship as more casual than professional, resulting in impaired objectivity or failure to maintain professional standards of behavior; or, finally, the online relationship results in an accidental breach of confidentiality that offends or harms the client in some way. 

The risk of harm by “friending” must also be weighed against the harm, albeit unlikely, that could come to the client by not accepting the request.  For example, the client may be inappropriately offended by the refusal, resulting in damage to the professional relationship.  This harm could likely be avoided through a frank discussion with the client about why the client wants to be Friends, and why the psychologist does or does not wish to accept.  If the psychologist does accept the request, there is still an obligation to be vigilant so that if harm occurs it can be minimized as quickly as possible.
 

If the FPA listserv may be considered a crude survey of the prevailing attitudes of psychologists, most maintain a policy to not accept Friend requests, and maintain strict controls over privacy on Facebook to prevent possible clients from viewing their personal profiles.  To “friend” a client is not automatically unethical, but clearly there are many risks with few apparent benefits, so the answer to the question posed in the title according to emerging consensus appears to be, “Not.”

Reference

Zur, O. & Zur, A. (2011). The Facebook Dilemma: To Accept or Not to Accept? Responding to Clients' "Friend Requests" on Psychotherapists' Social Networking Sites. Independent Practitioner, 31(1), pp. 12-17.