Big Pharma gives your doctor gifts. Then your doctor gives you Big Pharma’s drugs

Nicole Van Groningen
The Washington Post
Originally posted June 13, 2017

Here is an excerpt:

The losers in this pharmaceutical industry-physician interaction are, of course, patients. The high costs of branded drugs are revenue to drug companies, but out-of-pocket expenses to health-care consumers. Almost a quarter of Americans who take prescription drugs report that they have difficulty affording their medications, and the high costs of these drugs is a leading reason that patients can’t adhere to them. Most branded drugs offer minimal — if any — benefit over generic formulations. And if doctors prescribe brand-name drugs that are prohibitively more expensive than generic options, patients might forgo the medications altogether — causing greater harm.

On a national scale, the financial burden imposed by branded drugs is enormous. Current estimates place our prescription drug spending at more than $400 billion annually, and branded drugs are almost entirely to blame: Though they constitute only 10 percent of prescriptions, they account for 72 percent of total drug spending. Even modest reductions in our use of branded prescription drugs — on par with the roughly 8 percent relative reduction seen in the JAMA study — could translate to billions of dollars in national health-care savings.

The article is here.

How Gullible Are We? A Review of the Evidence From Psychology and Social Science.

Hugo Mercier
Review of General Psychology, May 18 , 2017

Abstract

A long tradition of scholarship, from ancient Greece to Marxism or some contemporary social psychology, portrays humans as strongly gullible—wont to accept harmful messages by being unduly deferent. However, if humans are reasonably well adapted, they should not be strongly gullible: they should be vigilant toward communicated information. Evidence from experimental psychology reveals that humans are equipped with well-functioning mechanisms of epistemic vigilance. They check the plausibility of messages against their background beliefs, calibrate their trust as a function of the source’s competence and benevolence, and critically evaluate arguments offered to them. Even if humans are equipped with well-functioning mechanisms of epistemic vigilance, an adaptive lag might render them gullible in the face of new challenges, from clever marketing to omnipresent propaganda. I review evidence from different cultural domains often taken as proof of strong gullibility: religion, demagoguery, propaganda, political campaigns, advertising, erroneous medical beliefs, and rumors. Converging evidence reveals that communication is much less influential than often believed—that religious proselytizing, propaganda, advertising, and so forth are generally not very effective at changing people’s minds. Beliefs that lead to costly behavior are even less likely to be accepted. Finally, it is also argued that most cases of acceptance of misguided communicated information do not stem from undue deference, but from a fit between the communicated information and the audience’s preexisting beliefs.

The article is here.

Nudges in a post-truth world

Neil Levy
Journal of Medical Ethics 
Published Online First: 19 May 2017

Abstract

Nudges—policy proposals informed by work in behavioural economics and psychology that are designed to lead to better decision-making or better behaviour—are controversial. Critics allege that they bypass our deliberative capacities, thereby undermining autonomy and responsible agency. In this paper, I identify a kind of nudge I call a nudge to reason, which make us more responsive to genuine evidence. I argue that at least some nudges to reason do not bypass our deliberative capacities. Instead, use of these nudges should be seen as appeals to mechanisms partially constitutive of these capacities, and therefore as benign (so far as autonomy and responsible agency are concerned). I sketch some concrete proposals for nudges to reason which are especially important given the apparent widespread resistance to evidence seen in recent political events.

The article is here.

Conviction, persuasion and manipulation: the ethical dimension of epistemic vigilance

Johannes Mahr
Cognition and Culture Institute Blog
Originally posted 10 March 2017

In today’s political climate moral outrage about (alleged) propaganda and manipulation of public opinion dominate our discourse. Charges of manipulative information provision have arguably become the most widely used tool to discredit one’s political opponent. Of course, one reason for why such charges have become so prominent is that the way we consume information through online media has made us more vulnerable than ever to such manipulation. Take a recent story published by The Guardian, which describes the strategy of information dissemination allegedly used by the British ‘Leave Campaign’:

“The strategy involved harvesting data from people’s Facebook and other social media profiles and then using machine learning to ‘spread’ through their networks. Wigmore admitted the technology and the level of information it gathered from people was ‘creepy’. He said the campaign used this information, combined with artificial intelligence, to decide who to target with highly individualised advertisements and had built a database of more than a million people.”

This might not just strike you as “creepy” but as simply unethical just as it did one commentator cited in the article who called these tactics “extremely disturbing and quite sinister”. Here, I want to investigate where this intuition comes from.

The blog post is here.

Nudges in a Post-Truth World

Neil Levy

Abstract

Nudges – policy proposals informed by work in behavioural economics and psychology that are designed to lead to better decision-making or better behaviour – are controversial. Critics allege that they bypass our deliberative capacities, thereby undermining autonomy and responsible agency. In this paper, I identify a kind of nudge I call a nudge to reason, which make us more responsive to genuine evidence. I argue that at least some nudges to reason do not bypass our deliberative capacities. Instead, use of these nudges should be seen as appeals to mechanisms partially constitutive of these capacities, and therefore as benign (so far as autonomy and responsible agency are concerned. I sketch some concrete proposals for nudges to reason which are especially important given the apparent widespread resistance to evidence seen in recent political events.

The article is here.

Making it moral: Merely labeling an attitude as moral increases its strength

Andrew Luttrella, Richard E. Pettya, Pablo Briñolb, & Benjamin C. Wagner
Journal of Experimental Social Psychology
Available online 27 April 2016

Abstract

Prior research has shown that self-reported moral bases of people's attitudes predict a range of important consequences, including attitude-relevant behavior and resistance in the face of social influence. Although previous studies typically rely on self-report measures of such bases, the present research tests the possibility that people can be induced to view their own attitudes as grounded in moral bases. This perception alone leads to outcomes associated with strong attitudes. In three experiments, participants were led to view their attitudes as grounded in moral or non-moral bases. Merely perceiving a moral (vs. non-moral) basis to one's attitudes led them to show greater correspondence with relevant behavioral intentions (Experiment 1) and become less susceptible to change following a persuasive message (Experiments 2 and 3). Moreover, these effects were independent of any other established indicators of attitude strength.

Highlights

• Mere perceptions of moral (vs. non-moral) attitude bases were manipulated.
• Perceiving a moral basis increased attitude–intention consistency.
• Perceiving a moral basis also led to greater resistance to persuasion.
• These effects were not mediated by other established attitude strength indicators.

The article is here.

The Man Who Studies the Spread of Ignorance

By Georgina Kenyon
BBC.com
6 January 2016

Here is an excerpt:

“We live in a world of radical ignorance, and the marvel is that any kind of truth cuts through the noise,” says Proctor. Even though knowledge is ‘accessible’, it does not mean it is accessed, he warns.

“Although for most things this is trivial – like, for example, the boiling point of mercury – but for bigger questions of political and philosophical import, the knowledge people have often comes from faith or tradition, or propaganda, more than anywhere else.”

Proctor found that ignorance spreads when firstly, many people do not understand a concept or fact and secondly, when special interest groups – like a commercial firm or a political group – then work hard to create confusion about an issue. In the case of ignorance about tobacco and climate change, a scientifically illiterate society will probably be more susceptible to the tactics used by those wishing to confuse and cloud the truth.

Consider climate change as an example. “The fight is not just over the existence of climate change, it’s over whether God has created the Earth for us to exploit, whether government has the right to regulate industry, whether environmentalists should be empowered, and so on. It’s not just about the facts, it’s about what is imagined to flow from and into such facts,” says Proctor.

The article is here.

Are Arguments about GMO Safety Really About Something Else?

By Gregory E. Kaebnick
The Hastings Center Blog
Originally published August 28, 2015

Here is an excerpt:

Saletan is trying to examine the impact of GMOs in more or less this objective way. Perhaps, however, the fiercer, dyed-in-the-wool opponents of GMOs are looking beyond health and safety, strictly construed in terms of quantifiable aspects of human well-being, to something else. One possibility is that they are indeed focused on health and safety but are put off by something about the particular form of the threat. Moral psychologists such as Paul Slovic and Daniel Kahneman have noted that the perception of a risk’s severity does not cleanly track the quantifiable outcomes. Different ways of dying may be perceived as better or worse, even though death is the measurable outcome in both cases. After September 11, 2001, air travel dropped significantly and many people who might have been expected to fly in planes, and safely reach their destinations, went by car instead and died in automobile accidents. Viewed strictly in terms of the quantifiable risk of death, the decision to go by car looks silly. But maybe, the risk assessor (and scholarly critic of risk assessment) Adam Finkel has proposed, what put people off flying was not the risk of death alone but the prospect of “death preceded by agonizing minutes of chaos and the awful opportunity of being able to contact loved ones before the grisly culmination of another’s suicide mission.”

The entire article is here.

How do people change their minds about issues?

By Brian Turner
ethicalsystems.org
Originally published

Here is an excerpt:

2) Pay attention to social intuitionism and speak to the “elephant” first.  One of the three main points of moral psychology is that intuitions come first and strategic reasoning comes second.  Unless we have a system for doing otherwise, we pretty much just go with our gut feeling and then confabulate. This means we subconsciously come up with reasons to justify our position that our mind conveniently serves us as “reasoned” evidence rather than the knee-jerk response that it actually is.

In other words, the person has to like you, or at least not dislike you, before they’ll be open to your message.  If the person doesn’t like you and you try to present your idea, it doesn’t matter how persuasive, articulate or evidence-based your comments are, they’re not going to change their mind.

This is one of the reasons why you can defeat every counterpoint that someone makes about your argument and they still won’t listen to you – you can’t intellectually bludgeon someone into changing their mind.

The entire blog post is here.

Editor's note: This blog post relates psychotherapy as well as other forms of persuasive communication.

U of T criticized for links between Big Pharma and Med Schools

By Georgia Williams
The Varsity
Originally published July 16, 2014

A recent report in the Journal of Medical Ethics took aim at the actions of university lecturers who have ties to pharmaceutical companies — including those at U of T.

The study — written by Dr. Navindra Persaud, a practicing physician at St. Michael’s Hospital — questions the validity of the content taught in one of the mandatory lecture series he attended as a medical student at the university in 2004. The lecture on pain pharmacotherapy used a modified classification chart from the World Health Organization (WHO) to show oxycodone as both a “weak and strong opioid,” comparable to codeine. However, as Dr. Persaud’s report indicates, oxycodone is at least  “1.5 times more potent than morphine” a drug that the WHO lists as a strong opioid. Dr. Persaud’s study also claims that the drug’s adverse side effects were downplayed by the lecturer.

The entire story is here.

Reviewing Autonomy

Implications of the Neurosciences and the Free Will Debate for the Principle of Respect for the Patient's Autonomy

Sabine Muller & Henrik Walter. Cambridge Quarterly of Healthcare Ethics. New York: Apr 2010. Vol. 19, Iss. 2; pg. 205, 13 pgs

Introduction

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience itself needs a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.

Beauchamp and Childress analyze autonomous actions in terms of normal choosers who act (1) intentionally, (2) with understanding, and (3) without controlling influences (coercion, persuasion, and manipulation) that determine their actions. ¹ In terms of the free will debate, the absence of external controlling influences, their third criterion, corresponds to the freedom of action: to do what one wants to do without being hindered to do so. Criteria one and two are related to volition: that a choice is intentional, that is, that it has a certain goal that is properly understood by the person choosing.

According to Beauchamp and Childress, the principle of autonomy implies that patients have the right to choose between different medical therapy options taking into account risks and benefits as well as their personal situation and individual values. To enable an autonomous decision the procedure of informed consent ² has been developed. This procedure has become the gold standard in almost every part of medicine. Importantly, Beauchamp and Childress demand respect for a patient's autonomy under the premise that the patient is able to act in a sufficiently autonomous manner. ³ The crucial question in a special situation is whether this is the case.

Let us consider the example of the recent controversial discussion of Body Integrity Identity disorder: ⁴ If a patient asks a physician to amputate one of his legs although it neither hurts nor is deformed, paralyzed, or ugly (in the patient's view), and if the patient understands the consequences of the amputation and is not controlled by external influences, then one could deduce from the principle of respect for the patient's autonomy that the physician should amputate the leg. Although some commentators regard this as self-evident, we think that the case is not yet made, as it is important which internal processes have led to the wish of the patient.

We propose to add a fourth criterion for autonomous actions, namely, freedom of internal coercive influences. In the case of the patient who desires an amputation, it would have to be investigated whether his decision is based on internal coercion. Clear examples for that would be an acute episode of schizophrenia or a brain tumor. More controversial are neurotic beliefs, obsession and compulsion, severe personality disorders, or neurological dysfunctions not accessible with conventional diagnostic tools.

Although Beauchamp and Childress have not elaborated the principle of autonomy with regard to internal coercions, they clearly argue that the obligations to respect autonomy do not apply to persons who show a substantial lack of autonomy because they are immature, incapacitated, ignorant, coerced, or exploited, for example, infants, irrationally suicidal individuals, severely demented subjects, or drug-dependent patients. ⁵ But these kinds of patients are treated in medical ethics as exceptions and therefore as marginal cases. They are not considered to be important for the formulation of the principles.

The rest of the article can be found here.  Without access to PubMed.gov, it is not available for free.  A university library may also be helpful in reading the entire article.