How to Navigate the Pitfalls of AI Hype in Health Care

Suran M, Hswen Y.

JAMA.

Published online January 03, 2024.

doi:10.1001/jama.2023.23330

What is AI snake oil, and how might it hinder progress within the medical field? What are the inherent risks in AI-driven automation for patient care, and how can we ensure the protection of sensitive patient information while maximizing its benefits?

When it comes to using AI in medicine, progress is important—but so is proceeding with caution, says Arvind Narayanan, PhD, a professor of computer science at Princeton University, where he directs the Center for Information Technology Policy.

The interview and the video is here.

Here is my summary:

• AI has the potential to revolutionize healthcare, but it is important to be aware of the hype and potential pitfalls.
• One of the biggest concerns is bias. AI algorithms can be biased based on the data they are trained on, which can lead to unfair or inaccurate results. For example, an AI algorithm that is trained on data from mostly white patients may be less accurate at diagnosing diseases in black patients.
• Another concern is privacy. AI algorithms require large amounts of data to work, and this data can be very sensitive. It is important to make sure that patient data is protected and that patients have control over how their data is used.
• It is also important to remember that AI is not a magic bullet. AI can be a valuable tool, but it is not a replacement for human judgment. Doctors and other healthcare professionals need to be able to critically evaluate the output of AI algorithms and make sure that it is being used in a safe and ethical way.

Overall, the interview is a cautionary tale about the potential dangers of AI in healthcare. It is important to be aware of the risks and to take steps to mitigate them. But it is also important to remember that AI has the potential to do a lot of good in healthcare. If we develop and use AI responsibly, it can help us to improve the quality of care for everyone.

Here are some additional points that were made in the interview:

• AI can be used to help with a variety of tasks in healthcare, such as diagnosing diseases, developing new treatments, and managing chronic conditions.
• There are a number of different types of AI, each with its own strengths and weaknesses.
• It is important to choose the right type of AI for the task at hand.
• AI should always be used in conjunction with human judgment.

Countertransference awareness and treatment outcome

Abargil, M., & Tishby, O. (2022). 

Journal of counseling psychology,

69(5), 667–677.

https://doi.org/10.1037/cou0000620

Abstract

Countertransference (CT) is considered a central component in the therapy process. Research has shown that CT management does not reduce the number of CT manifestations in therapy, but it leads to better therapy outcomes. In this study, we examined therapists' awareness of their CT using a structured interview. Our hypotheses were (a) treatments in which therapists were more aware of their CT would have a better outcome and (b) different definitions of CT would be related to different therapy outcomes. Twenty-nine patients were treated by 19 therapists in 16 sessions of short-term psychodynamic therapy. We used the core conflictual relationship theme to measure CT, a special interview was developed to study CT awareness. Results show that awareness of CT defined as the relationship with the patient moderated 10 outcome measures and awareness of CT defined as the relationship with the patient that repeats therapist conflicts with significant others moderated three outcome measures We present examples from dyads in this study and discuss how awareness can help the therapist talk to and handle patient challenges.

From the Discussion section

Increased therapist awareness of CT facilitate improvement in patient symptoms, emotion regulation and affiliation in relationships. Since awareness is an integral part of CT management, these findings are consistent with Hayes’ results from 2018 regarding the importance of CT management and its contribution to treatment outcome. Moreover, therapist’s self-awareness was found to be important in treating minorities (Baker, 1999). This study expands the ecological validity of therapist awareness and shows that the therapists’ awareness of their own wishes in therapy, as well as his perception of himself and the patient, is relevant to the general population as well. Thus, therapists of all theoretical orientations are encouraged to attend to their personal conflicts and to monitor their reactions to patients as a routine part of effective clinical practice. Moreover, therapist awareness has been found in the past to lead to less therapist self-confidence, but to better treatment outcomes (Williams, 2008). Our clinical examples illustrate these findings (the therapist who had high awareness showed much more self- doubt) and the results of multilevel regression analysis demonstrate better improvement for patients whose therapists were highly aware. Interestingly, the IIP control dimension was not found to be related to the therapist’s awareness of CT. It may be that since this dimension relates to the patient’s control need, the awareness of transference is more important. Another possibility is that the patient’s experience of the therapist as “knowing” may actually increase his control needs. Moreover, regarding patient main TC, we only found a trend and not a significant interaction. One reason may be the sample size. Another explanation is that patients do not necessarily link the changes in their lives to the relationship with the therapist and the insights associated with it. Thus, although awareness of CT helps to improve other outcome measures, it is not related to the way patients feel about the reason they sought out treatment.

A recent study of CT found that negative types of CT were correlated with more ruptures and less repair in the alliance. For positive CT the picture is more complex; Positive patterns predicted resolution when the therapists repeated positive patterns with par- ents but predicted ruptures when they tried to “repair” negative patterns with the parents (Tishby & Wiseman, 2020). The authors suggest that awareness of CT will help the therapist pay more attention to ruptures during treatment so they can address it and initiate resolutions processes. Our findings support the authors’ suggestion. The clinical example demonstrates that when the therapist was aware of negative CT and was able to talk about it in the awareness interview, he was also able to address the difficult feelings that arose during a session with the patient. Moreover, the treatment outcomes in these treatments were better which characterizes treatments with proper repair processes.

The article is paywalled here.

Recruiting Dark Personalities for Earnings Management

Harris, L., and others

Available at SSRN

http://dx.doi.org/10.2139/ssrn.3775120

Abstract

Prior research indicates that managers’ dark personality traits increase their tendency to engage in disruptive and unethical organizational behaviors including accounting earnings management. Other research suggests that the prevalence of dark personalities in management may represent an accidental byproduct of selecting managers with accompanying desirable attributes that fit the stereotype of a “strong leader.” Our paper posits that organizations may hire some managers who have dark personality traits because their willingness to push ethical boundaries aligns with organizational objectives, particularly in the accounting context where ethical considerations are especially important. Using several validation studies and experiments, we find that experienced executives and recruiting professionals favor hiring a candidate with dark personality traits into an accounting management position over an otherwise better-qualified candidate when the hiring organization faces pressure to manage earnings. Our results help to illuminate why individuals with dark personality traits may effectively compete for high-level accounting positions.

 Conclusion

This paper provides provocative evidence about the types of individuals who are hired into positions of power and authority in the accounting function of organizations. The results of our studies support our research hypothesis that, in the presence of earnings management pressure, job candidates who possess more dark personality traits (i.e., Candidate A) are more likely to be hired than candidates who possess fewer dark personality traits (i.e., Candidate B).  We also find that executive recruitment professionals are more likely to screen out candidates without dark personalities before they are considered by prospective employers. Our results arise despite the fact that (1) Candidate A is considered to be a significantly worse manager than Candidate B, (2) Candidate A is perceived to be more likely to engage in fraud than Candidate B, (3) Candidate A is perceived to be less likely to maintain high ethical standards in the face of

adversity than Candidate B, and (4) Candidate A is viewed by many as generally less likeable than Candidate B. We therefore conclude that the perceived willingness to push ethical boundaries, as signaled by dark personality traits, represents an important dimension of candidate fit and hiring potential when organizations face pressure to manage earnings. 

Why Good Ethics Are Now Big Business—And How To Embrace Them

Phil Lewis

Forbes.com

Originally published 14 Oct 20

Here is an excerpt:

“I think ethics cascading through the business, through the teams and managers, is very much about cascading the culture, but a culture that everyone understands. It’s about hiring the right people. People who share our values,” he explains. 

“And this wouldn’t work if you were just thinking about today or tomorrow as a business. But if you think about five years, or 10 years, or 50 years, the way Japanese businesses operate, looking after people, giving them a sense of purpose, making sure that the growth path of the business is also thinking about the growth path of the individual… If you really look after people, that intrinsic motivation will follow.”

It’s almost a karmic approach to business, then: do good things and good things will come to you. That’s an approach Pawlik has taken through the pandemic too—and it seems to be proving its worth. 

“When this happened, we were very much, ‘What do you need? Can I help you with strategy? Can I help you reach a new market and diversify? Whatever it is, let's put some time together, and you can ask questions, and I'll just help.’ I offered to do loads of free training to organizations, to support them. The approach was: let's just give them more value and see if we can help people. 

“And that came back tenfold. People were so happy with how we've supported them, that when they got stronger legs, they came back to us and said, ‘You know what? You really helped us through that difficult time period. You didn't need to, you didn't ask for anything back. And now we want to reciprocate.’ It's perfectly logical. Help people, and good things will come back.”

The info is here.

Why it now pays for businesses to put ethics before economics

John Drummond
The National
Originally published July 14, 2019

Here is an excerpt:

All major companies today have an ethics code or a statement of business principles. I know this because at one time my company designed such codes for many FTSE companies. And all of these codes enshrine a commitment to moral standards. And these standards are often higher than those required by law.

When the boards of companies agree to these principles they largely do so because they believe in them – at the time. However, time moves on. People move on. The business changes. Along the way, company people forget.

So how can you tell if a business still believes in its stated principles? Actually, it is very simple. When an ethical problem, such as Mossmorran, happens, look to see who turns up to answer concerns. If it is a public relations man or woman, the company has lost the plot. By contrast, if it is the executive who runs the business, then the company is likely still in close touch with its ethical standards.

Economics and ethics can be seen as a spectrum. Ethics is at one side of the spectrum and economics at the other. Few organisations, or individuals for that matter, can operate on purely ethical lines alone, and few operate on solely economic considerations. Most organisations can be placed somewhere along this spectrum.

So, if a business uses public relations to shield top management from a problem, it occupies a position closer to economics than to ethics. On the other hand, where corporate executives face their critics directly, then the company would be located nearer to ethics.

The info is here.

Why It’s Easier to Make Decisions for Someone Else

Evan Polman
Harvard Business Review
Originally posted November 13, 2018

Here is an excerpt:

What we found was two-fold: Not only did participants choose differently when it was for themselves rather than for someone else, but the way they chose was different. When choosing for themselves, participants focused more on a granular level, zeroing in on the minutiae, something we described in our research as a cautious mindset. Employing a cautious mindset when making a choice means being more reserved, deliberate, and risk averse. Rather than exploring and collecting a plethora of options, the cautious mindset prefers to consider a few at a time on a deeper level, examining a cross-section of the larger whole.

But when it came to deciding for others, study participants looked more at the array of options and focused on their overall impression. They were bolder, operating from what we called an adventurous mindset. An adventurous mindset prioritizes novelty over a deeper dive into what those options actually consist of; the availability of numerous choices is more appealing than their viability. Simply put, they preferred and examined more information before making a choice, and as my previous research has shown, they recommended their choice to others with more gusto.

These findings align with my earlier work with Kyle Emich of University of Delaware on how people are more creative on behalf of others. When we are brainstorming ideas to other people’s problems, we’re inspired; we have a free flow of ideas to spread out on the table without judgment, second-guessing, or overthinking.

The info is here.

Ethics Policies Don't Build Ethical Cultures

Dori Meinert
www.shrm.org
Originally posted June 19, 2018

Here is an excerpt:

Most people think they would never voluntarily commit an unethical or illegal act. But when Gallagher asked how many people in the audience had ever received a speeding ticket, numerous hands were raised. Similarly, employees rationalize their misuse of company supplies all the time, such as shopping online on their company-issued computer during work hours.

"It's easy to make unethical choices when they are socially acceptable," he said.

But those seemingly small choices can start people down a slippery slope.

Be on the Lookout for Triggers

No one plans to destroy their career by breaking the law or violating their company's ethics policy. There are usually personal stressors that push them over the edge, triggering a "fight or flight" response. At that point, they're not thinking rationally, Gallagher said.

Financial problems, relationship problems or health issues are the most common emotional stressors, he said.

"If you're going to be an ethical leader, are you paying attention to your employees' emotional triggers?"

The information is here.

Navigating Political Talk at Work

David W. Ballard
Harvard Business Review
Originally posted March 2, 2017

Here is an excerpt:

Managers should recognize that the current political environment could be having an effect on people, especially if they’re talking about it in the office. Be aware of employees’ stress levels, share information about benefits and resources that are available to help support them, and encourage appropriate use of your company’s employee assistance program, mental health benefits, flexible work arrangements, and workplace wellness activities that can help people stay healthy and functioning at their best.

Senior leaders and supervisors can communicate a powerful message by modeling the behavior and actions they’re trying to promote in the organization. By demonstrating civility and respect, actively using available support resources, participating in organizational activities, and managing their own stress levels in healthy ways, business leaders can back their words with actions that show they are serious about creating a healthy work environment.

Focusing on common goals and shared values is another way to bring people together despite their differences. As a manager, set clear goals for your team and focus people on working together toward common objectives. When political turmoil is creating tension and distraction, focusing on the work and accomplishing something together may be a welcome reprieve.

Finally, step in if things get too heated. If the current political climate is negatively affecting an employee’s job performance, address the issue before it creates a bigger problem. Provide the necessary feedback, work with the employee to create a plan, and point them to available resources that might help. When tensions turn into conflicts between coworkers, counsel employees on any relevant policies related to harassment or incivility, help them find ways to work together, and involve human resources as needed.

The article is here.

Working for an Algorithm Might Be an Improvement

By Elaine Ou
Bloomberg
Originally posted January 13, 2017

Here are two excerpts:

Bridgewater isn’t alone. Offices around the country are deploying tools to continuously monitor and assess employee activity. Complaints about the dehumanizing nature of working for algorithmic bosses such as Uber and Amazon have inspired comparisons to “Taylorism,” a scientific management theory remembered primarily for its use of stopwatches and specialized slide rules (like the one pictured below).

(cut)

Scientific management doesn’t have to be a dehumanizing experience. Dalio says that Bridgewater's management systems are designed to improve decision-making, conflict resolution, and personal development. This doesn’t necessarily mean removing managers from the equation; it simply recognizes that humans are unique and fallible, and ideally enables them to develop unbiased solutions. Dalio says that Bridgewater employees have a turnover rate of less than 6 percent after the first two years of attrition. Assuming his employees haven’t been turned into cyborgs, he's probably doing something right.

The article is here.

Relaxing Moral Reasoning to Win: How Organizational Identification Relates to Unethical Pro-Organizational Behavior.

Mo Chen, Chao C. Chen, and Oliver J. Sheldon
Journal of Applied Psychology, Apr 21 , 2016

Abstract

Drawing on social identity theory and social–cognitive theory, we hypothesize that organizational identification predicts unethical pro-organizational behavior (UPB) through the mediation of moral disengagement. We further propose that competitive interorganizational relations enhance the hypothesized relationships. Three studies conducted in China and the United States using both survey and vignette methodologies provided convergent support for our model. Study 1 revealed that higher organizational identifiers engaged in more UPB, and that this effect was mediated by moral disengagement. Study 2 found that organizational identification once again predicted UPB through the mediation of moral disengagement, and that the mediation relationship was stronger when employees perceived a higher level of industry competition. Finally, Study 3 replicated the above findings using a vignette experiment to provide stronger evidence of causality. Theoretical and practical implications are discussed.

An excerpt from the Managerial Implications section:

"In addition to these theoretical contributions, it is also worth briefly touching upon some implications of the present research for managerial practice. Unethical behaviors have proven costly for organizations (Cialdini et al., 2004), especially those behaviors conducted in the name of the organization, which are more likely to undermine stakeholders' organizational trust or even cause the collapse of an organization. In view of the dark side of organizational identification, managers should be aware of blind allegiance and loyalty to the organization among their employees and instead emphasize the importance of social responsibility and caring for all stakeholders. The linkage between organizational identification and moral disengagement we document here suggests that loyal organizational members are under greater pressure to relax their moral reasoning to execute their citizenship behavior, especially when stakes are high in a competitive environment. To counterbalance the tendency toward moral disengagement, organizations and managers need to clearly highlight the importance of hyper ethical values in organizational policies and practices and integrate such ethical standards into managerial decision-making. At the same time, organizations should strive to create a culture of social responsibility so as to reduce UPB (May et al., 2015) and reinforce ethical pro-organizational behavior."

The article is here.

Turning To Ethics When Trust In Business Is At An All-Time Low

By Dina Medland
Forbes
Originally posted July 24, 2014

Here is an excerpt:

The latest report from the UK’s  Institute of Business Ethics  (IBE) sets out why company directors need to be actively involved in setting and maintaining a company’s ethical values. One of the lessons of the 2008 banking crisis has been that ethics matters to business, both in terms of its reputation and its sustainability, writes Peter Montagnon, Associate Director  in Ethics, Risk & Governance: a board briefing paper. The challenge for business is how to develop and embed real values in order to regain public trust, needed if they are to secure their franchise for the long term.

The entire article is here.