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 Precision Medicine. Show all posts
Showing posts with label Precision Medicine. Show all posts

Monday, October 24, 2022

Ethical considerations for precision psychiatry: A roadmap for research and clinical practice

Fusar-Poli, P., Manchia, M., et al. (2022, October). 
European Neuropsychopharmacology, 63, 17–34.
https://doi.org/10.1016/j.euroneuro.2022.08.001

Abstract

Precision psychiatry is an emerging field with transformative opportunities for mental health. However, the use of clinical prediction models carries unprecedented ethical challenges, which must be addressed before accessing the potential benefits of precision psychiatry. This critical review covers multidisciplinary areas, including psychiatry, ethics, statistics and machine-learning, healthcare and academia, as well as input from people with lived experience of mental disorders, their family, and carers. We aimed to identify core ethical considerations for precision psychiatry and mitigate concerns by designing a roadmap for research and clinical practice. We identified priorities: learning from somatic medicine; identifying precision psychiatry use cases; enhancing transparency and generalizability; fostering implementation; promoting mental health literacy; communicating risk estimates; data protection and privacy; and fostering the equitable distribution of mental health care. We hope this blueprint will advance research and practice and enable people with mental health problems to benefit from precision psychiatry.

From the Results section

3.1. Ethics of precision psychiatry: Key concepts

Broadly speaking, ethical issues concern the development of ‘practical ought claims’ (Sheehan and Dunn, 2013) (i.e. normative claims that are practical in nature), which arise when we face ethical uncertainty in precision psychiatry. These practical claims come schematically like this: how should somebody or a group of people act in relation to a particular issue when they face certain circumstances? For example, how should researchers inform patients about their individualised risk estimates after running a novel clinical prediction model? To address these questions, four overarching ethical principles have been suggested (by Beauchamp and Childress) (Beauchamp and Childress, 2019), which include autonomy, beneficence, non-maleficence and justice. These can be applied to precision psychiatry, complemented by an extra principle of “explainability/interpretability” (Panel 1) which has been specifically introduced for artificial intelligence (Floridi et al., 2018) (for a more detailed discussion of ethical platforms for big data analytics see eSupplementary 1).

Although these four principles have become the cornerstones of biomedical ethics in healthcare practice, they have been criticised as they are often conflicting with no clear hierarchy and are not very specific (i.e. these principles are somewhat implicit, representing general moral values), leading to “imprecise ethics” that may not fit the needs of precision psychiatry (Table 1). Rather we should ask ourselves “why” a certain act may be harmful or beneficial. For example, let's imagine having a risk assessment; what would that mean for the individual, their family planning, workplace, choosing their studies, or their period of life? Alternatively, let's imagine that the risk assessment is not performed; what would be the results in a few years’ time? To address these sorts of questions, this study will consider ethical values in a broader sense, for example, by taking into account some of the different principles present in the charter of fundamental rights of the European Union – starting from dignity, freedom, equality, solidarity, citizens’ rights and justice (Table 1) (European Union, 2012; Hallinan, 2021). In particular, human dignity and human flourishing are the most crucial elements from an ethical point of view that are tightly linked to autonomy and self-determination (which is modulated by several factors such as physical health, psychological state, sociocultural environment, as well as values and beliefs). The loss of insight associated with some psychiatric disorders may incapacitate the individual to make autonomous decisions. For example, autonomy emerged as the driving decision component for undergoing risk prediction testing among young populations (Mantell et al., 2021a), regardless of whether a person would decide for or against risk profiling. Finally, it is important to highlight that unique ethical considerations may be associated with the historically complex socio-political perceptions and attitudes towards severe mental disorders and psychiatry (Ball et al., 2020a; Manchia et al., 2020a).

Wednesday, February 20, 2019

Precision medicine’s rosy predictions haven’t come true. We need fewer promises and more debate

Michael Joyner and Nigel Paneth
STATnews.com
Originally published February 7, 2019

Here is an excerpt:

While we are occasionally told that we are Luddites or nihilists (generally without much debate of the merits of our position), the most frequent communications we receive have been along the lines of “I agree with you, but can’t speak up publicly for fear of losing my grants, alienating powerful people, or upsetting my dean.” This atmosphere cannot be good for the culture of science.

We are calling for an open debate, in all centers of biomedical research, about the best way forward, and about whether precision medicine is really the most promising avenue for progress. It is time for precision medicine supporters to engage in debate — to go beyond asserting the truism that all individuals are unique, and that the increase in the volume of health data and measurements combined with the decline in the cost of studying the genome constitute sufficient argument for the adoption of the precision medicine program.

Enthusiasts of precision medicine must stop evading the tough questions we raise. The two of us have learned enormously from the free and open exchange of ideas among our small band of dissenters, and we look forward to a vigorous debate engaging an ever-larger fraction of the scientific community.

The info is here.

Sunday, June 10, 2018

Can precision medicine do for depression what it’s done for cancer? It won’t be easy

Megan Thielking
Statnews.com
Originally posted May 9, 2018

At a growing number of research centers across the country, scientists are scanning brains of patients with depression, drawing their blood, asking about their symptoms, and then scouring that data for patterns. The goal: pinpoint subtypes of depression, then figure out which treatments have the best chance of success for each particular variant of the disease.

The idea of precision medicine for depression is quickly gaining ground — just last month, Stanford announced it is establishing a Center for Precision Mental Health and Wellness. And depression is one of many diseases targeted by All of Us, the National Institute of Health campaign launched this month to collect DNA and other data from 1 million Americans. Doctors have been treating cancer patients this way for years, but the underlying biology of mental illness is not as well understood.

“There’s not currently a way to match people with treatment,” said Dr. Madhukar Trivedi, a depression researcher at the University of Texas Southwestern Medical Center. “That’s why this is a very exciting field to research.”

The information is here.

Thursday, July 13, 2017

Professors lead call for ethical framework for new 'mind control' technologies

Medical Xpress
Originally published July 6, 2017

Here is an excerpt:

As advances in molecular biology and chemical engineering are increasing the precision of pharmaceuticals, even more spatially-targeted technologies are emerging. New noninvasive treatments send electrical currents or magnetic waves through the scalp, altering the ability of neurons in a targeted region to fire. Surgical interventions are even more precise; they include implanted electrodes that are designed to quell seizures before they spread, or stimulate the recall of memories after a traumatic brain injury.

Research into the brain's "wiring"—how neurons are physically connected in networks that span disparate parts of the brain—and how this wiring relates to changing mental states has enabled principles from control theory to be applied to neuroscience. For example, a recent study by Bassett and colleagues shows how changes in brain wiring from childhood through adolescence leads to greater executive function, or the ability to consciously control one's thoughts and attention.

While insights from network science and control theory may support new treatments for conditions like obsessive compulsive disorder and traumatic brain injury, the researchers argue that clinicians and bioethicists must be involved in the earliest stages of their development. As the positive effects of treatments become more profound, so do their potential side effects.

"New methods of controlling mental states will provide greater precision in treatments," Sinnott-Armstrong said, "and we thus need to think hard about the ensuing ethical issues regarding autonomy, privacy, equality and enhancement."

The article is here.

Friday, March 24, 2017

The Privacy Delusions Of Genetic Testing

Peter Pitts
Forbes
Originally posted February 15, 2017

Here is an excerpt:

The problem starts with the Health Insurance Portability and Accountability Act (HIPAA), a 1996 federal law that allows medical companies to share and sell patient data if it has been "anonymized," or scrubbed of any obvious identifying characteristics.

The Portability Act was passed when genetic testing was just a distant dream on the horizon of personalized medicine. But today, that loophole has proven to be a cash cow. For instance, 23andMe has sold access to its database to at least 13 outside pharmaceutical firms. One buyer, Genentech, ponied up a cool $10 million for the genetic profiles of people suffering from Parkinson's. AncestryDNA, another popular personal genetics company, recently announced a lucrative data-sharing partnership with the biotech company Calico.

Wednesday, January 4, 2017

Actuaries are bringing Netflix-like predictive modeling to health care

By Gary Gau
STAT News
Originally published on December 13, 2016

Here is an excerpt:

In today’s ever-changing landscape, the health actuary is part clinician, epidemiologist, health economist, and statistician. He or she combines financial, operational, and clinical data, such as information from electronic medical records, pharmacy use, and lab results, to provide insights on both individual patients and overall population health.

I see a future where predictive modeling helps health care companies not only suggest healthy behaviors but also convince patients and consumers to adopt them. Predictive modeling techniques can be applied to information that can influence an individual’s decision to use preventive care, accurately take prescribed medication, book a doctor appointment, lose weight, or become more physically active.

The trick will be identifying the trigger that gets him or her to act.

Insurers must understand their patient populations, including the barriers they face to achieving better health. To create solutions, insurers must first understand the psychology of motivation and what leads individuals to change their behavior. That’s where the precision approach comes into play.

The article is here.

Saturday, January 30, 2016

Epigenetics in the neoliberal 'regime of truth'

by Charles Dupras and Vardit Ravitsky
Hastings Center Report - 2015

Here is an excerpt:

In this paper, we argue that the impetus to create new biomedical interventions to manipulate and reverse epigenetic variants is likely to garner more attention than effective social and public health interventions and therefore also to garner a greater share of limited public resources. This is likely to happen, we argue, because of the current biopolitical context in  which scientific findings are translated. This contemporary neoliberal “regime of truth,” to use a term from the historian and philosopher Michel Foucault, greatly influences the ways in which knowledge is being interpreted and implemented. Building on sociologist Thomas Lemke’s Foucauldian “analytics of biopolitics” and on literature from the field of science and technology studies,  we present two sociological trends that may impede the policy transla-tion of epigenetics: molecularization and biomedicalization. These trends,  we argue, are likely to favor the clini-cal translation of epigenetics—in other words, the development of new clinical tools fostering what has been called “personalized” or “precision” medicine.

In addition, we argue that an over-emphasized clinical translation of epigenetics may further reinforce this biopolitical landscape through four processes that are closely related to neoliberal pathways of thinking: the internalization and isolation (liberal individualism) of socioenvironmental determinants of health and increased opportunities for commodification and technologicalization  (economic liberalism) of health care interventions. Hence, epigenetics may end up promoting further the mobilization of resources toward technological innovation at the expense of public health and social strategies. Our analysis therefore first presents how the current biopolitical landscape may bias scientific knowledge translation and then circles around to explain how, in return, the outcome of a biased translation of epigenetics may strengthen our contemporary neoliberal “regime of truth.”

The paper is here.