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 Race. Show all posts
Showing posts with label Race. Show all posts

Thursday, May 23, 2024

Extracting intersectional stereotypes from embeddings: Developing and validating the Flexible Intersectional Stereotype Extraction procedure

Charlesworth, T. E. S., et al. (2024).
PNAS Nexus, 3(3).

Abstract

Social group–based identities intersect. The meaning of “woman” is modulated by adding social class as in “rich woman” or “poor woman.” How does such intersectionality operate at-scale in everyday language? Which intersections dominate (are most frequent)? What qualities (positivity, competence, warmth) are ascribed to each intersection? In this study, we make it possible to address such questions by developing a stepwise procedure, Flexible Intersectional Stereotype Extraction (FISE), applied to word embeddings (GloVe; BERT) trained on billions of words of English Internet text, revealing insights into intersectional stereotypes. First, applying FISE to occupation stereotypes across intersections of gender, race, and class showed alignment with ground-truth data on occupation demographics, providing initial validation. Second, applying FISE to trait adjectives showed strong androcentrism (Men) and ethnocentrism (White) in dominating everyday English language (e.g. White + Men are associated with 59% of traits; Black + Women with 5%). Associated traits also revealed intersectional differences: advantaged intersectional groups, especially intersections involving Rich, had more common, positive, warm, competent, and dominant trait associates. Together, the empirical insights from FISE illustrate its utility for transparently and efficiently quantifying intersectional stereotypes in existing large text corpora, with potential to expand intersectionality research across unprecedented time and place. This project further sets up the infrastructure necessary to pursue new research on the emergent properties of intersectional identities.

Significance Statement

Stereotypes at the intersections of social groups (e.g. poor man) may induce unique beliefs not visible in parent categories alone (e.g. poor or men). Despite increased public and research awareness of intersectionality, empirical evidence on intersectionality remains understudied. Using large corpora of naturalistic English text, the Flexible Intersectional Stereotype Extraction procedure is introduced, validated, and applied to Internet text to reveal stereotypes (in occupations and personality traits) at the intersection of gender, race, and social class. The results show the dominance (frequency) and halo effects (positivity) of powerful groups (White, Men, and Rich), amplified at group intersections. Such findings and methods illustrate the societal significance of how language embodies, propagates, and even intensifies stereotypes of intersectional social categories.

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Here is a summary:

This article presents a novel method, the Flexible Intersectional Stereotype Extraction (FISE) procedure, for systematically identifying and validating intersectional stereotypes from language models.

Intersectional stereotypes, which capture the unique biases associated with the intersection of multiple social identities (e.g. race and gender), are a critical area of study for understanding and addressing prejudice and discrimination.

The ability to reliably extract and validate intersectional stereotypes from large language datasets can provide clinical psychologists with valuable insights into the cognitive biases and social perceptions that may influence clinical assessment, diagnosis, and treatment.

Understanding the prevalence and nature of intersectional stereotypes can help clinical psychologists develop more culturally-sensitive and inclusive practices, as well as inform interventions aimed at reducing bias and promoting equity in mental healthcare.

The FISE method demonstrated in this research can be applied to a variety of clinical and psychological datasets, allowing for the systematic study of intersectional biases across different domains relevant to clinical psychology.

In summary, this research on extracting and validating intersectional stereotypes is highly relevant for clinical psychologists, as it provides a rigorous approach to identifying and addressing the complex biases that can impact the assessment, diagnosis, and treatment of diverse patient populations.

Monday, May 13, 2024

Ethical Considerations When Confronted by Racist Patients

Charles Dike
Psychiatric News
Originally published 26 Feb 24

Here is an excerpt:

Abuse of psychiatrists, mostly verbal but sometimes physical, is common in psychiatric treatment, especially on inpatient units. For psychiatrists trained decades ago, experiencing verbal abuse and name calling from patients—and even senior colleagues and teachers—was the norm. The abuse began in medical school, with unconscionable work hours followed by callous disregard of students’ concerns and disparaging statements suggesting the students were too weak or unfit to be doctors.

This abuse continued into specialty training and practice. It was largely seen as a necessary evil of attaining the privilege of becoming a doctor and treating patients whose uncivil behaviors can be excused on account of their ill health. Doctors were supposed to rise above those indignities, focus on the task at hand, and get the patients better in line with our core ethical principles that place caring for the patient above all else. There was no room for discussion or acknowledgement of the doctors’ underlying life experiences, including past trauma, and how patients’ behavior would affect doctors.

Moreover, even in recent times, racial slurs or attacks against physicians of color were not recognized as abuse by the dominant group of doctors; the affected physicians who complained were dismissed as being too sensitive or worse. Some physicians, often not of color, have explained a manic patient’s racist comments as understandable in the context of disinhibition and poor judgment, which are cardinal symptoms of mania, and they are surprised that physicians of color are not so understanding.


Here is a summary:

This article explores the ethical dilemma healthcare providers face when treating patients who express racist views. It acknowledges the provider's obligation to care for the patient's medical needs, while also considering the emotional toll of racist remarks on both the provider and other staff members.

The article discusses the importance of assessing the urgency of the patient's medical condition and their mental capacity. It explores the option of setting boundaries or termination of treatment in extreme cases, while also acknowledging the potential benefits of attempting a dialogue about the impact of prejudice.

Wednesday, April 3, 2024

Perceptions of Falling Behind “Most White People”: Within-Group Status Comparisons Predict Fewer Positive Emotions and Worse Health Over Time Among White (but Not Black) Americans

Caluori, N., Cooley, E., et al. (2024).
Psychological Science, 35(2), 175-190.
https://doi.org/10.1177/09567976231221546

Abstract

Despite the persistence of anti-Black racism, White Americans report feeling worse off than Black Americans. We suggest that some White Americans may report low well-being despite high group-level status because of perceptions that they are falling behind their in-group. Using census-based quota sampling, we measured status comparisons and health among Black (N = 452, Wave 1) and White (N = 439, Wave 1) American adults over a period of 6 to 7 weeks. We found that Black and White Americans tended to make status comparisons within their own racial groups and that most Black participants felt better off than their racial group, whereas most White participants felt worse off than their racial group. Moreover, we found that White Americans’ perceptions of falling behind “most White people” predicted fewer positive emotions at a subsequent time, which predicted worse sleep quality and depressive symptoms in the future. Subjective within-group status did not have the same consequences among Black participants.


Here is my succinct summary:

Despite their high group status, many White Americans experience poor well-being due to the perception that they are lagging behind their in-group. In contrast, Black Americans feel relatively better off within their racial group, while White Americans feel comparatively worse off within theirs.

Friday, February 16, 2024

Citing Harms, Momentum Grows to Remove Race From Clinical Algorithms

B. Kuehn
JAMA
Published Online: January 17, 2024.
doi:10.1001/jama.2023.25530

Here is an excerpt:

The roots of the false idea that race is a biological construct can be traced to efforts to draw distinctions between Black and White people to justify slavery, the CMSS report notes. For example, the third US president, Thomas Jefferson, claimed that Black people had less kidney output, more heat tolerance, and poorer lung function than White individuals. Louisiana physician Samuel Cartwright, MD, subsequently rationalized hard labor as a way for slaves to fortify their lungs. Over time, the report explains, the medical literature echoed some of those ideas, which have been used in ways that cause harm.

“It is mind-blowing in some ways how deeply embedded in history some of this misinformation is,” Burstin said.

Renewed recognition of these harmful legacies and growing evidence of the potential harm caused by structural racism, bias, and discrimination in medicine have led to reconsideration of the use of race in clinical algorithms. The reckoning with racial injustice sparked by the May 2020 murder of George Floyd helped accelerate this work. A few weeks after Floyd’s death, an editorial in the New England Journal of Medicine recommended reconsidering race in 13 clinical algorithms, echoing a growing chorus of medical students and physicians arguing for change.

Congress also got involved. As a Robert Wood Johnson Foundation Health Policy Fellow, Michelle Morse, MD, MPH, raised concerns about the use of race in clinical algorithms to US Rep Richard Neal (D, MA), then chairman of the House Ways and Means Committee. Neal in September 2020 sent letters to several medical societies asking them to assess racial bias and a year later he and his colleagues issued a report on the misuse of race in clinical decision-making tools.

“We need to have more humility in medicine about the ways in which our history as a discipline has actually held back health equity and racial justice,” Morse said in an interview. “The issue of racism and clinical algorithms is one really tangible example of that.”


My summary: There's increasing worry that using race in clinical algorithms can be harmful and perpetuate racial disparities in healthcare. This concern stems from a recognition of the historical harms of racism in medicine and growing evidence of bias in algorithms.

A review commissioned by the Agency for Healthcare Research and Quality (AHRQ) found that using race in algorithms can exacerbate health disparities and reinforce the false idea that race is a biological factor.

Several medical organizations and experts have called for reevaluating the use of race in clinical algorithms. Some argue that race should be removed altogether, while others advocate for using it only in specific cases where it can be clearly shown to improve outcomes without causing harm.

Sunday, February 11, 2024

Assessing the potential of GPT-4 to perpetuate racial and gender biases in health care: a model evaluation study

Zack, T., Lehman, E., et al (2024).
The Lancet Digital Health, 6(1), e12–e22.

Summary

Background

Large language models (LLMs) such as GPT-4 hold great promise as transformative tools in health care, ranging from automating administrative tasks to augmenting clinical decision making. However, these models also pose a danger of perpetuating biases and delivering incorrect medical diagnoses, which can have a direct, harmful impact on medical care. We aimed to assess whether GPT-4 encodes racial and gender biases that impact its use in health care.

Methods

Using the Azure OpenAI application interface, this model evaluation study tested whether GPT-4 encodes racial and gender biases and examined the impact of such biases on four potential applications of LLMs in the clinical domain—namely, medical education, diagnostic reasoning, clinical plan generation, and subjective patient assessment. We conducted experiments with prompts designed to resemble typical use of GPT-4 within clinical and medical education applications. We used clinical vignettes from NEJM Healer and from published research on implicit bias in health care. GPT-4 estimates of the demographic distribution of medical conditions were compared with true US prevalence estimates. Differential diagnosis and treatment planning were evaluated across demographic groups using standard statistical tests for significance between groups.

Findings

We found that GPT-4 did not appropriately model the demographic diversity of medical conditions, consistently producing clinical vignettes that stereotype demographic presentations. The differential diagnoses created by GPT-4 for standardised clinical vignettes were more likely to include diagnoses that stereotype certain races, ethnicities, and genders. Assessment and plans created by the model showed significant association between demographic attributes and recommendations for more expensive procedures as well as differences in patient perception.

Interpretation

Our findings highlight the urgent need for comprehensive and transparent bias assessments of LLM tools such as GPT-4 for intended use cases before they are integrated into clinical care. We discuss the potential sources of these biases and potential mitigation strategies before clinical implementation.

Thursday, October 12, 2023

Patients need doctors who look like them. Can medicine diversify without affirmative action?

Kat Stafford
apnews.com
Originally posted 11 September 23

Here are two excerpts:

But more than two months after the Supreme Court struck down affirmative action in college admissions, concerns have arisen that a path into medicine may become much harder for students of color. Heightening the alarm: the medical field’s reckoning with longstanding health inequities.

Black Americans represent 13% of the U.S. population, yet just 6% of U.S. physicians are Black. Increasing representation among doctors is one solution experts believe could help disrupt health inequities.

The disparities stretch from birth to death, often beginning before Black babies take their first breath, a recent Associated Press series showed. Over and over, patients said their concerns were brushed aside or ignored, in part because of unchecked bias and racism within the medical system and a lack of representative care.

A UCLA study found the percentage of Black doctors had increased just 4% from 1900 to 2018.

But the affirmative action ruling dealt a “serious blow” to the medical field’s goals of improving that figure, the American Medical Association said, by prohibiting medical schools from considering race among many factors in admissions. The ruling, the AMA said, “will reverse gains made in the battle against health inequities.”

The consequences could affect Black health for generations to come, said Dr. Uché Blackstock, a New York emergency room physician and author of “LEGACY: A Black Physician Reckons with Racism in Medicine.”

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“As medical professionals, any time we see disparities in care or outcomes of any kind, we have to look at the systems in which we are delivering care and we have to look at ways that we are falling short,” Wysong said.

Without affirmative action as a tool, career programs focused on engaging people of color could grow in importance.

For instance, the Pathways initiative engages students from Black, Latino and Indigenous communities from high school through medical school.

The program starts with building interest in dermatology as a career and continues to scholarships, workshops and mentorship programs. The goal: Increase the number of underrepresented dermatology residents from about 100 in 2022 to 250 by 2027, and grow the share of dermatology faculty who are members of color by 2%.

Tolliver credits her success in becoming a dermatologist in part to a scholarship she received through Ohio State University’s Young Scholars Program, which helps talented, first-generation Ohio students with financial need. The scholarship helped pave the way for medical school, but her involvement in the Pathways residency program also was central.

Monday, September 25, 2023

The Young Conservatives Trying to Make Eugenics Respectable Again

Adam Serwer
The Atlantic
Originally posted 15 September 23

Here are two excerpts:

One explanation for the resurgence of scientific racism—what the psychologist Andrew S. Winston defines as the use of data to promote the idea of an “enduring racial hierarchy”—is that some very rich people are underwriting it. Mathias notes that “rich benefactors, some of whose identities are unknown, have funneled hundreds of thousands of dollars into a think tank run by Hanania.” As the biological anthropologist Jonathan Marks tells the science reporter Angela Saini in her book Superior, “There are powerful forces on the right that fund research into studying human differences with the goal of establishing those differences as a basis of inequalities.”

There is no great mystery as to why eugenics has exerted such a magnetic attraction on the wealthy. From god emperors, through the divine right of kings, to social Darwinism, the rich have always sought an uncontestable explanation for why they have so much more money and power than everyone else. In a modern, relatively secular nation whose inequalities of race and class have been shaped by slavery and its legacies, the justifications tend toward the pseudoscience of an unalterable genetic aristocracy with white people at the top and Black people at the bottom.

“The lay concept of race does not correspond to the variation that exists in nature,” the geneticist Joseph L. Graves wrote in The Emperor’s New Clothes: Biological Theories of Race at the Millennium. “Instead, the American concept of race is a social construction, resulting from the unique political and cultural history of the United States.”

Because race is a social reality, genuine disparities among ethnic groups persist in measures such as education and wealth. Contemporary believers in racial pseudoscience insist these disparities must necessarily have a genetic explanation, one that happens to correspond to shifting folk categories of race solidified in the 18th century to justify colonialism and enslavement. They point to the external effects of things like war, poverty, public policy, and discrimination and present them as caused by genetics. For people who have internalized the logic of race, the argument may seem intuitive. But it is just astrology for racists.

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Race is a sociopolitical category, not a biological one. There is no genetic support for the idea that humans are divided into distinct races with immutable traits shared by others who have the same skin color. Although qualified geneticists have debunked the shoddy arguments of race scientists over and over, the latter maintain their relevance in part by casting substantive objections to their assumptions, methods, and conclusions as liberal censorship. There are few more foolproof ways to get Trump-era conservatives to believe falsehoods than to insist that liberals are suppressing them. Race scientists also understand that most people can evaluate neither the pseudoscience they offer as proof of racial differences nor the actual science that refutes it, and will default to their political sympathies.

Three political developments helped renew this pseudoscience’s appeal. The first was the election of Barack Obama, an emotional blow to those adhering to the concept of racial hierarchy from which they have yet to recover. Then came the rise of Bernie Sanders, whose left-wing populism blamed the greed of the ultra-wealthy for the economic struggles of both the American working class and everyone in between. Both men—one a symbol of racial equality, the other of economic justice—drew broad support within the increasingly liberal white-collar workforce from which the phrenologist billionaires of Big Tech draw their employees. The third was the election of Donald Trump, itself a reaction to Obama and an inspiration to those dreaming of a world where overt bigotry does not carry social consequences.


Here is my brief synopsis:

Young conservatives are often influenced by far-right ideologues who believe in the superiority of the white race and the need to improve the human gene pool.  Serwer argues that the resurgence of interest in eugenics is part of a broader trend on the right towards embracing racist and white supremacist ideas. He also notes that the pseudoscience of race is being used to justify hierarchies and provide an enemy to rail against.

It is important to note that eugenics is a dangerous and discredited ideology. It has been used to justify forced sterilization, genocide, and other atrocities. The resurgence of interest in eugenics is a threat to all people, especially those who are already marginalized and disadvantaged.

Tuesday, January 31, 2023

Why VIP Services Are Ethically Indefensible in Health Care

Denisse Rojas Marquez and Hazel Lever
AMA J Ethics. 2023;25(1):E66-71.
doi: 10.1001/amajethics.2023.66.

Abstract

Many health care centers make so-called VIP services available to “very important persons” who have the ability to pay. This article discusses common services (eg, concierge primary care, boutique hotel-style hospital stays) offered to VIPs in health care centers and interrogates “trickle down” economic effects, including the exacerbation of inequity in access to health services and the maldistribution of resources in vulnerable communities. This article also illuminates how VIP care contributes to multitiered health service delivery streams that constitute de facto racial segregation and influence clinicians’ conceptions of what patients deserve from them in health care settings.

Insurance and Influence

It is common practice for health care centers to make “very important person” (VIP) services available to patients because of their status, wealth, or influence. Some delivery models justify the practice of VIP health care as a means to help offset the cost of less profitable sectors of care, which often involve patients who have low income, are uninsured, and are from historically marginalized communities.1 In this article, we explore the justification of VIP health care as helping finance services for patients with low income and consider if this “trickle down” rationale is valid and whether it should be regarded as acceptable. We then discuss clinicians’ ethical responsibilities when taking part in this system of care.

We use the term VIP health care to refer to services that exceed those offered or available to a general patient population through typical health insurance. These services can include concierge primary care (also called boutique or retainer-based medicine) available to those who pay out of pocket, stays on exclusive hospital floors with luxury accommodations, or other premium-level health care services.1 Take the example of a patient who receives treatment on the “VIP floor” of a hospital, where she receives a private room, chef-prepared food, and attending physician-only services. In the outpatient setting, the hallmarks of VIP service are short waiting times, prompt referrals, and round-the-clock staffing.

While this model of “paying for more” is well accepted in other industries, health care is a unique commodity, with different distributional consequences than markets for other goods (eg, accessing it can be a matter of life or death and it is deemed a human right under the Alma-Ata Declaration2). The existence of VIP health care creates several dilemmas: (1) the reinforcement of existing social inequities, particularly racism and classism, through unequal tiers of care; (2) the maldistribution of resources in a resource-limited setting; (3) the fallacy of financing care of the underserved with care of the overserved in a profit-motivated system.

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Conclusion

VIP health care, while potentially more profitable than traditional health care delivery, has not been shown to produce better health outcomes and may distribute resources away from patients with low incomes and patients of color. A system in which wealthy patients are perceived to be the financial engine for the care of patients with low incomes can fuel distorted ideas of who deserves care, who will provide care, and how expeditiously care will be provided. To allow VIP health care to exist condones the notion that some people—namely, wealthy White people—deserve more care sooner and that their well-being matters more. When health institutions allow VIP care to flourish, they go against the ideal of providing equitable care to all, a value often named in organizational mission statements.22 At a time when pervasive distrust in the medical system has fueled negative consequences for communities of color, it is our responsibility as practitioners to restore and build trust with the most vulnerable in our health care system. When evaluating how VIP care fits into our health care system, we should let health equity be a moral compass for creating a more ethical system.

Tuesday, January 3, 2023

Varieties of White working-class identity

Knowles, E., McDermott, M., & Richeson, J.
(2021, July 2).
https://doi.org/10.31234/osf.io/mjhdy

Abstract

The present work demonstrates that, contrary to popular political narratives, working-class White Americans are far from monolithic in their class identities, social attitudes, and political preferences. Latent profile analysis (LPA) is used to distinguish three types of identity in a nationally representative sample of working-class Whites: Working Class Patriots, who valorize responsibility, embrace national identity, and disparage the poor; Class Conflict Aware, who regard social class as a structural phenomenon and ascribe elitist attitudes to higher classes; and Working Class Connected, who embrace working-class identity, sympathize with the poor, and feel disrespected because of the work they do. This identity typology appears unique to working-class Whites and is associated with distinct patterns of attitudes regarding immigration, race, and politics, such that Class Conflict Aware and Working Class Connected Whites are considerably more progressive than are Working Class Patriots. Implications for electoral politics and race relations are discussed.

Discussion

Despite often being characterized as a monolithic social and political force, members of theWhite working class display considerable diversity in their intergroup attitudes and voting behavior(Smith & Hanley, 2018; Teixeira & Rogers, 2000; Tyson & Maniam, 2016). In an ethnographic study of working-class Whites in Kentucky, Missouri, and Indiana, McDermott and colleagues(2019) identified three identity types among White working-class interviewees:  Working ClassPatriots, who identity strongly as American, emphasize responsibility, disparage the poor, and report feeling respected in their jobs; Class Conflict Aware Whites, who see the working class as locked in a conflictual relationship with socioeconomic elites; and Working Class Connected Whites, who identify strongly as members of the working class, feel compassion toward the poor, and report feeling looked down on because of the work they do. These researchers found that the three identity types were associated with different patterns of social attitudes—with Patriots tending to disparage Black people and Latino immigrants, Conflict Aware Whites displaying progressive attitudes toward these groups, and Class Connected Whites exhibiting a combination of tolerant attitudes toward immigrants and hostile attitudes toward Black people.

The present research represents a quantitative extension of these qualitative findings. In a nationally representative sample of working-class (non–college-educated) White Americans, we measured five themes emerging from previous qualitative work: American identification, the value placed on responsibility, psychological distance from the poor, the belief in stark divisions between social classes, and the tendency to feel looked down on by members of higher classes. Latent profile analysis (LPA) was then used to assess whether the White American population contains discrete types resembling the Working Class Patriot, Class Conflict Aware, and Working Class Connected groups. Indeed, the best LPA solution yielded three identity types based on our five indicators, and these types could be readily matched to those found in McDermott et al.’s (2019) qualitative work(Figure 1a). The representation of the types in our survey sample broadly matched the breakdown in the ethnographic study—with Patriots making up the majority of respondents and the remaining sample split roughly between Class Conflict Aware and Working Class Connected Whites.


Psychologists need to understand that white working class culture is not monolithic, just like other cultures.

Monday, May 23, 2022

Recognizing and Dismantling Raciolinguistic Hierarchies in Latinx Health

Ortega, P., et al.
AMA J Ethics. 2022;24(4):E296-304.
doi: 10.1001/amajethics.2022.296.

Abstract

Latinx individuals represent a linguistically and racially diverse, growing US patient population. Raciolinguistics considers intersections of language and race, prioritizes lived experiences of non-English speakers, and can help clinicians more deftly conceptualize heterogeneity and complexity in Latinx health experiences. This article discusses how raciolinguistic hierarchies (ie, practices of attaching social value to some languages but not others) can undermine the quality of Latinx patients’ health experiences. This article also offers language-appropriate clinical and educational strategies for promoting health equity.

Raciolinguistics

Hispanic/Latinx (hereafter, Latinx) individuals in the United States represent a culturally, racially, and linguistically diverse and rapidly growing population. Attempting to categorize all Latinx individuals in a single homogeneous group may result in inappropriate stereotyping,1 inaccurate counting,2, 3 ineffective health interventions that insufficiently target at-risk subgroups,4 and suboptimal health communication.5 A more helpful approach is to use raciolinguistics to conceptualize the heterogeneous, complex Latinx experience as it relates to health. Raciolinguistics is the study of the historical and contemporary co-naturalization of race and language and their intertwining in the identities of individuals and communities. As an emerging field that grapples with the intersectionality of language and race, raciolinguistics provides a unique perspective on the lived experiences of people who speak non-English languages and people of color.6 As such, understanding raciolinguistics is relevant to providing language-concordant care7 to patients with limited English proficiency (LEP), who have been historically marginalized by structural barriers, racism, and other forms of discrimination in health care.

In this manuscript, we explore how raciolinguistics can help clinicians to appropriately conceptualize the heterogeneous, complex Latinx experience as it relates to health care. We then use the raciolinguistic perspective to inform strategies to dismantle structural barriers to health equity for Latinx patients pertaining to (1) Latinx patients’ health care experiences and (2) medical education.

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Conclusions

A raciolinguistic perspective can inform how health care practices and medical education should be critically examined to support Latinx populations comprising heterogeneous communities and complex individuals with varying and intersecting cultural, social, linguistic, racial, ancestral, spiritual, and other characteristics. Future studies should explore the outcomes of raciolinguistic reforms of health services and educational interventions across the health professions to ensure effectiveness in improving health care for Latinx patients.

Saturday, May 14, 2022

Suicides of Psychologists and Other Health Professionals: National Violent Death Reporting System Data, 2003–2018

Li, T., Petrik, M. L., Freese, R. L., & Robiner, W. N.
(2022). American Psychologist. 
Advance online publication.

Abstract

Suicide is a prevalent problem among health professionals, with suicide rates often described as exceeding that of the general population. The literature addressing suicide of psychologists is limited, including its epidemiological estimates. This study explored suicide rates in psychologists by examining the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention’s data set of U.S. violent deaths. Data were examined from participating states from 2003 to 2018. Trends in suicide deaths longitudinally were examined. Suicide decedents were characterized by examining demographics, region of residence, method of suicide, mental health, suicidal ideation, and suicidal behavior histories. Psychologists’ suicide rates are compared to those of other health professionals. Since its inception, the NVDRS identified 159 cases of psychologist suicide. Males comprised 64% of decedents. Average age was 56.3 years. Factors, circumstances, and trends related to psychologist suicides are presented. In 2018, psychologist suicide deaths were estimated to account for 4.9% of suicides among 10 selected health professions. As the NVDRS expands to include data from all 50 states, it will become increasingly valuable in delineating the epidemiology of suicide for psychologists and other health professionals and designing prevention strategies. 

From the Discussion

Between 2003 and 2018, 159 cases of psychologist death by suicide were identified in the NVDRS, providing a basis for examining the phenomenon rather than clarifying its true incidence. Suicide deaths spanned all U.S. regions, with the South accounting for the most (35.8%) cases, followed by the West (24.5%), Midwest (20.1%), and Northeast (19.5%). It is unclear whether this is due to the South and West actually having higher suicide rates among psychologists or if these regions have greater representation due to inclusion of more reporting states. It should also be noted that these regions make up different proportions of the population for the entire United States. According to the U.S. Census Bureau (n.d.), the proportion of each region’s population as compared to the entire U.S. population for the year 2019 was South (38.3%), West (23.9%), Midwest (20.8%), and Northeast (17.1%). This could have affected the number of cases seen within each region, as could other factors, such as the trend for gun ownership to be more than twice as common in the South than in the Northeast (Pew Research Center, 2017). The 2003–2018 psychologist suicide deaths were more than 13 times higher than NVDRS-identified psychologist homicide deaths (n = 12) for that same period (Robiner & Li, 2022).

The number of psychologist suicides identified in the NVDRS generally increased longitudinally. It is not clear whether this might signal an actual increasing incidence, and if so what factors may be contributing, or how much it is an artifact of the increasing number of NVDRS-reporting states. Starting in 2020, the data will more clearly reveal temporal patterns, with variation reflecting changes in suicide incidence rather than how many states reported. In the future, we anticipate longitudinal trends will not be confounded by variation in the number of reporting states.

Most psychologist suicide decedents were White (92.5%). Smaller percentages were Black, Indigenous, and People of Color (BIPOC): Black (2.5%), Asian or Pacific Islander (1.9%), and two or more races (3.1%). These proportions align largely with the racial/ethnic makeup of the psychologist workforce in APA’s Survey of Psychology Health Service Providers for White (87.8%), Black (2.6%), Asian (2.5%), and multiracial/multiethnic psychologists (1.7%; Hamp et al., 2016). The data are generally consistent with earlier findings of psychologist suicide (Phillips, 1999) that most psychologist suicide decedents are White and reveal slightly greater diversification within the field. CDC data from 2019 reveals rates in the general population of suicide per 100,000 are greatest in Whites (29.8 male, 8 female), followed by Blacks (12.4 male, 2.9 female), Asians (11.2 male, 4.0 female), and Hispanics (11.3 male, 3.0 female; NIMH, 2021). There were no cases of Hispanic psychologist suicide in this sample, which is generally consistent with the relatively lower numbers of suicides reported for Hispanics by the CDC. The relatively small numbers of suicides within subgroups limit the certainty of inferences that can be drawn about the association of ethnicity, and potentially other demographics, and suicide incidence. As the demographic composition of the field diversifies, the durability of the present findings for subgroups remains to be seen.

Wednesday, May 11, 2022

Bias in mental health diagnosis gets in the way of treatment

Howard N. Garb
psyche.co
Originally posted 2 MAR 22

Here is an excerpt:

What about race-related bias? 

Research conducted in the US indicates that race bias is a serious problem for the diagnosis of adult mental disorders – including for the diagnosis of PTSD, depression and schizophrenia. Preliminary data also suggest that eating disorders are underdiagnosed in Black teens compared with white and Hispanic teens.

The misdiagnosis of PTSD can have significant economic consequences, in addition to its implications for treatment. In order for a US military veteran to receive disability compensation for PTSD from the Veterans Benefits Administration, a clinician has to diagnose the veteran. To learn if race bias is present in this process, a research team compared its own systematic diagnoses of veterans with diagnoses made by clinicians during disability exams. Though most clinicians will make accurate diagnoses, the research diagnoses can be considered more accurate, as the mental health professionals who made them were trained to adhere to diagnostic criteria and use extensive information. When veterans received a research diagnosis of PTSD, they should have also gotten a clinician’s diagnosis of PTSD – but this occurred only about 70 per cent of the time.

More troubling is that, in cases where research diagnoses of PTSD were made, Black veterans were less likely than white veterans to receive a clinician’s diagnosis of PTSD during their disability exams. There was one set of cases where bias was not evident, however. In roughly 25 per cent of the evaluations, clinicians administered a formal PTSD symptom checklist or a psychological test to help them make a diagnosis – and if this additional information was collected, race bias was not observed. This is an important finding. Clinicians will sometimes form a first impression of a patient’s condition and then ask questions that can confirm – but not refute – their subjective impression. By obtaining good-quality objective information, clinicians might be less inclined to depend on their subjective impressions alone.

Race bias has also been found for other forms of mental illness. Historically, research indicated that Black patients and sometimes Hispanic patients were more likely than white patients to be given incorrect diagnoses of schizophrenia, while white patients were more often given correct diagnoses of major depression and bipolar disorder. During the past 20 years, this appears to have changed somewhat, with the most accurate diagnoses being made for Latino patients, the least accurate for Black patients, and the results for white patients somewhere in between.

Tuesday, May 3, 2022

The Mystifying Rise of Child Suicide

Andrew Solomon
The New Yorker
Originally posted 4 APR 22

Here are two excerpts:

Every suicide creates a vacuum. Those left behind fill it with stories that aspire to rationalize their ultimately unfathomable plight. People may blame themselves or others, cling to small crumbs of comfort, or engage in pitiless self-laceration; many do all this and more. In a year of interviewing the people closest to Trevor, I saw all of these reactions and experienced some of them myself. I came to feel a love for Trevor, which I hadn’t felt when he was alive. The more I understood the depths of his vulnerability, the more I wished that I had encouraged my son, whose relationship with Trevor was often antagonistic, to befriend him. As I interviewed Trevor’s parents, my relationship with them changed. The need to write objectively without increasing their suffering made it more fraught—but it also became deeper and more loving. As the April 6th anniversary of Trevor’s death approached, I started to share their hope that this article would be a kind of memorial to him.

Angela was right that a larger issue is at stake. The average age of suicides has been falling for a long time while the rate of youth suicide has been rising. Between 1950 and 1988, the proportion of adolescents aged between fifteen and nineteen who killed themselves quadrupled. Between 2007 and 2017, the number of children aged ten to fourteen who did so more than doubled. It is extremely difficult to generalize about youth suicide, because the available data are so much sparser and more fragmentary than for adult mental illness, let alone in the broader field of developmental psychology. What studies there are have such varied parameters—of age range, sample size, and a host of demographic factors—as to make collating the information all but impossible. The blizzard of conflicting statistics points to our collective ignorance about an area in which more and better studies are urgently needed. Still, in 2020, according to the Centers for Disease Control and Prevention, in the United States suicide claimed the lives of more than five hundred children between the ages of ten and fourteen, and of six thousand young adults between fifteen and twenty-four. In the former group, it was the second leading cause of death (behind unintentional injury). This makes it as common a cause of death as car crashes.

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Perhaps the most unsettling aspect of child suicide is its unpredictability. A recent study published in the Journal of Affective Disorders found that about a third of child suicides occur seemingly without warning and without any predictive signs, such as a mental-health diagnosis, though sometimes a retrospective analysis points to signs that were simply missed. Jimmy Potash, the chair of the psychiatry department at Johns Hopkins, told me that a boy who survived a suicide attempt described the suddenness of the impulse: seeing a knife in the kitchen, he thought, I could stab myself with that, and had done so before he had time to think about it. When I spoke to Christine Yu Moutier, who is the chief medical officer at the American Foundation for Suicide Prevention, she told me that, in children, “the moment of acute suicidal urge is very short-lived. It’s almost like the brain can’t keep up that rigid state of narrowed cognition for long.” This may explain why access to means is so important; children living in homes with guns have suicide rates more than four times higher than those of other children.

Saturday, April 2, 2022

Race and reactions to women's expressions of anger at work: Examining the effects of the "angry Black woman" stereotype

Motro, D., Evans, J. B., Ellis, A., & Benson, L. 
(2022). The Journal of applied psychology, 
107(1), 142–152.
https://doi.org/10.1037/apl0000884

Abstract

Across two studies (n = 555), we examine the detrimental effects of the "angry black woman" stereotype in the workplace. Drawing on parallel-constraint-satisfaction theory, we argue that observers will be particularly sensitive to expressions of anger by black women due to widely held stereotypes. In Study 1, we examine a three-way interaction among anger, race, and gender, and find that observers are more likely to make internal attributions for expressions of anger when an individual is a black woman, which then leads to worse performance evaluations and assessments of leadership capability. In Study 2, we focus solely on women and expand our initial model by examining stereotype activation as a mechanism linking the effects of anger and race on internal attributions. We replicated findings from Study 1 and found support for stereotype activation as an underlying mechanism. We believe our work contributes to research on race, gender, and leadership, and highlights an overlooked stereotype in the management literature. Theoretical and practical implications are discussed.

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Conclusion 

Black employees have to overcome a myriad of hurdles at work based on the color of their skin. For black women, our research indicates that there may be additional considerations when identifying biases at work. Anger is an emotion that employees may display in a variety of contexts, often stemming from a
perceived injustice. Bolstered by cultural reinforcement, our studies suggest that the angry black woman stereotype can affect how individuals view displays of anger at work. The angry black woman stereotype represents another hurdle for black women, and we urge future research to expand upon our understanding of the effects of perceptions on black women at work.

Monday, April 12, 2021

Structuring Local Environments to Avoid Diversity: Anxiety Drives Whites’ Geographical and Institutional Self-Segregation Preferences

Anicich, E., Jachimowicz, J., 
(2021, February 16). 
https://doi.org/10.31234/osf.io/yzpr2

Abstract

The current research explores how local racial diversity affects Whites’ efforts to structure their local communities to avoid incidental intergroup contact. In two experimental studies (N=509; Studies 1a-b), we consider Whites’ choices to structure a fictional, diverse city and find that Whites choose greater racial segregation around more (vs. less) self-relevant landmarks (e.g., their workplace and children’s school). Specifically, the more time they expect to spend at a landmark, the more they concentrate other Whites around that landmark, thereby reducing opportunities for incidental intergroup contact. Whites also structure environments to reduce incidental intergroup contact by instituting organizational policies that disproportionately exclude non-Whites: Two large-scale archival studies (Studies 2a-b) using data from every U.S. tennis (N=15,023) and golf (N=10,949) facility revealed that facilities in more racially diverse communities maintain more exclusionary barriers (e.g., guest policies, monetary fees, dress codes) that shield the patrons of these historically White institutions from incidental intergroup contact. In a final experiment (N=307; Study 3), we find that Whites’ anticipated intergroup anxiety is one driver of their choices to structure environments to reduce incidental intergroup contact in more (vs. less) racially diverse communities. Our results suggest that despite increasing racial diversity, White Americans structure local environments to fuel a self-perpetuating cycle of segregation.

General Discussion

Across five studies using a mix of experimental, archival, and survey methods, we provide evidence of a cycle of intergroup avoidance that is reflected in Whites’ efforts to structure their local environments in ways that reduce incidental intergroup contact: Whites experience more intergroup anxiety in the face of local racial diversity, and as such, work to segregate themselves geographically and institutionally from racial outgroup members. This, in turn, reduces the likelihood of incidental intergroup contact, which has the potential for debiasing effects.Specifically, in Studies 1a and 1b, we found that when given the opportunity to do so, Whites exhibited a preference to racially self-segregate when making decisions about the racial distribution of residents in a diverse city even in a controlled experimental setting. In Studies 2a and 2b, we constructed a rich archival dataset using information about every tennis and golf facility in the United States. We found that the gatekeepers of these historically White institutions restrict access in more versus less racially diverse communities by maintaining private (vs. public) access, higher monetary barriers, and stricter dress codes. Finally, Study 3experimentally manipulated the racial composition of a fictitious city and found that Whites who imagined living in a more versus less racially diverse city more strongly endorsed exclusionary policies in their institutions and anticipated feeling more stressed when confronted with the prospect of navigating through a diverse part of town, effects which were statistically mediated by feelings of intergroup anxiety.

Taken together, the current research offers important insights into how local racial diversity shapes Whites’ intergroup avoidance strategies, and ultimately results in Whites structuring communities in ways that reduce incidental intergroup contact and the frequency of potentially debiasing encounters.Moreover, such decisions block critical opportunities (economic, social, etc.) for racial minorities themselves, thus contributing to the persistence of structural racism, even in the face of increasing racial diversity (see also Kraus & Torrez, 2020).

Friday, February 5, 2021

Shaking Things Up: Unintended Consequences of Firm Acquisitions on Racial and Gender Inequality

Letian Zhang
Harvard Business School
Originally published 23 Jan20

Abstract

This paper develops a theory of how disruptive events shape organizational inequality.  Despite various organizational efforts, racial and gender inequality in the workplace remains high. I theorize that because the persistence of such inequality is reinforced by organizational structures and practices, disruptive events that shake up old hierarchies and break down routines and culture should give racial minority and women workers more opportunities to advance. To examine this theory, I explore a critical but seldom analyzed organizational event in the inequality literature - mergers and acquisitions. I propose that post-acquisition restructuring could offer an opportunity for firms to advance diversity initiatives and to objectively re-evaluate workers. Using a difference-in-differences design on a nationally representative sample covering 37,343 acquisitions from 1971 to 2015, I find that although acquisitions lead to occupational reconfiguration that favors higher-skilled workers, they also reduce racial and gender inequality. In particular, I find improved managerial representation of racial minorities and women and reduced racial and gender segregation in the acquired workplace. This post-acquisition effect is stronger when (a) the acquiring firm values race and gender equality more and (b) the acquired workplace had higher racial and gender inequality.  These findings suggest that disruptive events could produce an unintended consequence of increasing racial and gender equality in the workplace.

Managerial Implications

From a managerial perspective, disruptive events offer an opportunity to advance diversity or equality-related goals that might be difficult to pursue during normal times.  As my analyses show, acquisition amplifies the race and gender differences between those acquiring firms that value diversity and those that do not. For managers concerned about race and gender issues, acquisitions and other disruptive events might serve as suitable moments to improve race and gender gaps effectively and at a relatively lower cost. Thus, despite the disruption and uncertainty during these periods, managers should see disruptive events as prime opportunities to make positive changes.

Saturday, September 19, 2020

Don’t ask if artificial intelligence is good or fair, ask how it shifts power

Pratyusha Kalluri
nature.com
Originally posted 7 July 20

Here is an excerpt:

Researchers in AI overwhelmingly focus on providing highly accurate information to decision makers. Remarkably little research focuses on serving data subjects. What’s needed are ways for these people to investigate AI, to contest it, to influence it or to even dismantle it. For example, the advocacy group Our Data Bodies is putting forward ways to protect personal data when interacting with US fair-housing and child-protection services. Such work gets little attention. Meanwhile, mainstream research is creating systems that are extraordinarily expensive to train, further empowering already powerful institutions, from Amazon, Google and Facebook to domestic surveillance and military programmes.

Many researchers have trouble seeing their intellectual work with AI as furthering inequity. Researchers such as me spend our days working on what are, to us, mathematically beautiful and useful systems, and hearing of AI success stories, such as winning Go championships or showing promise in detecting cancer. It is our responsibility to recognize our skewed perspective and listen to those impacted by AI.

Through the lens of power, it’s possible to see why accurate, generalizable and efficient AI systems are not good for everyone. In the hands of exploitative companies or oppressive law enforcement, a more accurate facial recognition system is harmful. Organizations have responded with pledges to design ‘fair’ and ‘transparent’ systems, but fair and transparent according to whom? These systems sometimes mitigate harm, but are controlled by powerful institutions with their own agendas. At best, they are unreliable; at worst, they masquerade as ‘ethics-washing’ technologies that still perpetuate inequity.

Already, some researchers are exposing hidden limitations and failures of systems. They braid their research findings with advocacy for AI regulation. Their work includes critiquing inadequate technological ‘fixes’. Other researchers are explaining to the public how natural resources, data and human labour are extracted to create AI.

The info is here.

Tuesday, February 11, 2020

How to build ethical AI

Carolyn Herzog
thehill.com
Originally posted 18 Jan 20

Here is an excerpt:

Any standard-setting in this field must be rooted in the understanding that data is the lifeblood of AI. The continual input of information is what fuels machine learning, and the most powerful AI tools require massive amounts of it. This of course raises issues of how that data is being collected, how it is being used, and how it is being safeguarded.

One of the most difficult questions we must address is how to overcome bias, particularly the unintentional kind. Let’s consider one potential application for AI: criminal justice. By removing prejudices that contribute to racial and demographic disparities, we can create systems that produce more uniform sentencing standards. Yet, programming such a system still requires weighting countless factors to determine appropriate outcomes. It is a human who must program the AI, and a person’s worldview will shape how they program machines to learn. That’s just one reason why enterprises developing AI must consider workforce diversity and put in place best practices and control for both intentional and inherent bias.

This leads back to transparency.

A computer can make a highly complex decision in an instant, but will we have confidence that it’s making a just one?

Whether a machine is determining a jail sentence, or approving a loan, or deciding who is admitted to a college, how do we explain how those choices were made? And how do we make sure the factors that went into that algorithm are understandable for the average person?

The info is here.

Monday, February 10, 2020

Can Robots Reduce Racism And Sexism?

Kim Elsesser
Forbes.com
Originally posted 16 Jan 20

Robots are becoming a regular part of our workplaces, serving as supermarket cashiers and building our cars. More recently they’ve been tackling even more complicated tasks like driving and sensing emotions. Estimates suggest that about half of the work humans currently do will be automated by 2055, but there may be a silver lining to the loss of human jobs to robots. New research indicates that robots at work can help reduce prejudice and discrimination.

Apparently, just thinking about robot workers leads people to think they have more in common with other human groups according to research published in American Psychologist. When the study participants’ awareness of robot workers increased, they became more accepting of immigrants and people of a different religion, race, and sexual orientation.

Basically, the robots reduced prejudice by highlighting the existence of a group that is not human. Study authors, Joshua Conrad Jackson, Noah Castelo and Kurt Gray, summarized, “The large differences between humans and robots may make the differences between humans seem smaller than they normally appear. Christians and Muslims have different beliefs, but at least both are made from flesh and blood; Latinos and Asians may eat different foods, but at least they eat.” Instead of categorizing people by race or religion, thinking about robots made participants more likely to think of everyone as belonging to one human category.

The info is here.

Thursday, January 9, 2020

How implicit bias harms patient care

Jeff Bendix
medicaleconomics.com
Originally posted 25 Nov 19

Here is an excerpt:

While many people have difficulty acknowledging that their actions are influenced by unconscious biases, the concept is particularly troubling for doctors, who have been trained to view—and treat—patients equally, and the vast majority of whom sincerely believe that they do.

“Doctors have been molded throughout medical school and all our training to be non-prejudiced when it comes to treating patients,” says James Allen, MD, a pulmonologist and medical director of University Hospital East, part of Ohio State University’s Wexner Medical Center. “It’s not only asked of us, it’s demanded of us, so many physicians would like to think they have no biases. But it’s not true. All human beings have biases.”

“Among physicians, there’s a stigma attached to any suggestion of racial bias,” adds Penner. “And were a person to be identified that way, there could be very severe consequences in terms of their career prospects or even maintaining their license.”

Ironically, as Penner and others point out, the conditions under which most doctors practice today—high levels of stress, frequent distractions, and brief visits that allow little time to get to know patients--are the ones most likely to heighten their vulnerability to unintentional biases.

“A doctor under time pressure from a backlog of overdue charting and whatever else they’re dealing with will have a harder time treating all patients with the same level of empathy and concern,” van Ryn says.

The info is here.