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 Risk. Show all posts
Showing posts with label Risk. Show all posts

Tuesday, January 1, 2019

AI4People—An Ethical Framework for a Good AI Society: Opportunities, Risks, Principles, and Recommendations

Floridi, L., Cowls, J., Beltrametti, M. et al.
Minds & Machines (2018).
https://doi.org/10.1007/s11023-018-9482-5

Abstract

This article reports the findings of AI4People, an Atomium—EISMD initiative designed to lay the foundations for a “Good AI Society”. We introduce the core opportunities and risks of AI for society; present a synthesis of five ethical principles that should undergird its development and adoption; and offer 20 concrete recommendations—to assess, to develop, to incentivise, and to support good AI—which in some cases may be undertaken directly by national or supranational policy makers, while in others may be led by other stakeholders. If adopted, these recommendations would serve as a firm foundation for the establishment of a Good AI Society.

Tuesday, September 18, 2018

The So-Called Right to Try Law Gives Patients False Hope

Claudia Wallis
Scientific American
Originally posted in the September 2018 issue

There's no question about it: the new law sounds just great. President Donald Trump, who knows a thing or two about marketing, gushed about its name when he signed the “Right to Try” bill into law on May 30. He was surrounded by patients with incurable diseases, including a second grader with Duchenne muscular dystrophy, who got up from his small wheelchair to hug the president. The law aims to give such patients easier access to experimental drugs by bypassing the Food and Drug Administration.

The crowd-pleasing name and concept are why 40 states had already passed similar laws, although they were largely symbolic until the federal government got onboard. The laws vary but generally say that dying patients may seek from drugmakers any medicine that has passed a phase I trial—a minimal test of safety. “We're going to be saving tremendous numbers of lives,” Trump said. “The current FDA approval process can take many, many years. For countless patients, time is not what they have.”

But the new law won't do what the president claims. Instead it gives false hope to the most vulnerable patients. “This is a right to ask, not a right to try,” says Alison Bateman-House, a medical ethicist at New York University and an expert on the compassionate use of experimental drugs.

The info is here.

Wednesday, July 25, 2018

Heuristics and Public Policy: Decision Making Under Bounded Rationality

Sanjit Dhami, Ali al-Nowaihi, and Cass Sunstein
SSRN.com
Posted June 20, 2018

Abstract

How do human beings make decisions when, as the evidence indicates, the assumptions of the Bayesian rationality approach in economics do not hold? Do human beings optimize, or can they? Several decades of research have shown that people possess a toolkit of heuristics to make decisions under certainty, risk, subjective uncertainty, and true uncertainty (or Knightian uncertainty). We outline recent advances in knowledge about the use of heuristics and departures from Bayesian rationality, with particular emphasis on growing formalization of those departures, which add necessary precision. We also explore the relationship between bounded rationality and libertarian paternalism, or nudges, and show that some recent objections, founded on psychological work on the usefulness of certain heuristics, are based on serious misunderstandings.

The article can be downloaded here.

Wednesday, June 27, 2018

Experts outline ethics issues with use of genealogy DNA to solve crimes

Carolyn Crist
Business Insider
Originally published June 1, 2018

With recent revelations that U.S. law enforcement can - and already has - dipped into consumer genealogy DNA databases to help solve crimes, experts say more discussion of the ethical issues raised by this unintended use of personal information is needed.

It's unclear, for instance, whether online genealogy site users know their DNA is available to criminal investigators - and whether they'd object to it being used for that purpose, write the authors of an essay exploring the topic in the Annals of Internal Medicine.

"We're seeing a divide about this right now. On one hand, it's a powerful technology to solve cases, but it also raises questions for consumers," said lead author Benjamin Berkman, who heads the section on the ethics of genetics and new technologies at the National Institutes of Health's Department of Bioethics in Bethesda, Maryland.

"The idea that they upload their data for genealogy purposes and it's used in such a different way really surprises some people," he told Reuters Health in a telephone interview. "The terms of service agreements don't explain this clearly, and even if they did, people wouldn't read it or find it in the dense legalese."

The information is here.

Saturday, January 20, 2018

Exploiting Risk–Reward Structures in Decision Making under Uncertainty

Christina Leuker Thorsten Pachur Ralph Hertwig Timothy Pleskac
PsyArXiv Preprints
Posted December 21, 2017

Abstract

People often have to make decisions under uncertainty — that is, in situations where the probabilities of obtaining a reward are unknown or at least difficult to ascertain. Because outside the laboratory payoffs and probabilities are often correlated, one solution to this problem might be to infer the probability from the magnitude of the potential reward. Here, we investigated how the mind may implement such a solution: (1) Do people learn about risk–reward relationships from the environment—and if so, how? (2) How do learned risk–reward relationships impact preferences in decision-making under uncertainty? Across three studies (N = 352), we found that participants learned risk–reward relationships after being exposed to choice environments with a negative, positive, or uncorrelated risk–reward relationship. They learned the associations both from gambles with explicitly stated payoffs and probabilities (Experiments 1 & 2) and from gambles about epistemic
events (Experiment 3). In subsequent decisions under uncertainty, participants exploited the learned association by inferring probabilities from the magnitudes of the payoffs. This inference systematically influenced their preferences under uncertainty: Participants who learned a negative risk–reward relationship preferred the uncertain option over a smaller sure option for low payoffs, but not for high payoffs. This pattern reversed in the positive condition and disappeared in the uncorrelated condition. This adaptive change in preferences is consistent with the use of the risk–reward heuristic.

From the Discussion Section:

Risks and rewards are the pillars of preference. This makes decision making under uncertainty a vexing problem as one of those pillars—the risks, or probabilities—is missing (Knight, 1921; Luce & Raiffa, 1957). People are commonly thought to deal with this problem by intuiting subjective probabilities from their knowledge and memory (Fox & Tversky, 1998; Tversky & Fox, 1995) or by estimating statistical probabilities from samples of information (Hertwig & Erev, 2009). Our results support another ecologically grounded solution, namely, that people estimate the missing probabilities from their immediate choice environments via their learned risk–reward relationships.

The research is here.

Sunday, June 4, 2017

Physicians, Firearms, and Free Speech

Wendy E. Parmet, Jason A. Smith, and Matthew Miller
N Engl J Med 2017; 376:1901-1903
May 18, 2017

Here is an excerpt:

The majority’s well-reasoned decision, in fact, does just that. By relying on heightened rather than strict scrutiny, the majority affirmed that laws regulating physician speech must be designed to enhance rather than harm patient safety. The majority took this mandate seriously and required the state to show some meaningful evidence that the regulation was apt to serve the state’s interest in protecting patients.

The state could not do so for two reasons. First, the decision to keep a gun in the home substantially increases the risk of death for all household members, especially the risk of death by suicide, and particularly so when guns are stored loaded and unlocked, as they are in millions of homes where children live.  Second, the majority of U.S. adults who live in homes with guns are unaware of the heightened risk posed by bringing guns into a home.  Indeed, by providing accurate information about the risks created by easy access to firearms, as well as ways to modify that risk (e.g., by storing guns unloaded and locked up, separate from ammunition), a physician’s counseling can not only enhance a patient’s capacity for self-determination, but also save lives.

Given the right to provide such counsel, professional norms recognize the responsibility to do so. Fulfilling this obligation, however, may not be easy, since the chief impediments to doing so — and to doing so effectively — are not and never have been legal barriers. Indeed, the court’s welcome ruling does not ensure that most clinicians will honor this hard-won victory by exercising their First Amendment rights.

The article is here.

Monday, February 22, 2016

Will Your Ethics Hold Up Under Pressure?

Ron Carucci
Forbes
Originally published FEB 3, 2016

Here is an excerpt:

In an ironic appeal to self-interest, for which Haidt readily acknowledges the paradox, he says there are four important reasons “ethics pays.” First, there is the cost of reputation, which most analysts and experts acknowledge links closely to share price performance. Second, ethical organizations have lower costs of capital, as evidenced by Deutsche Bank’s commitment to focus on clients with higher ethical standards. Third, the white-hot war for talent, both recruiting and retaining top talent, takes a painful hit with an ethical scandal. Conversely, the best talent wants to associate with the best reputed companies. And finally, the astronomical cost of cleaning up an ethical mess can soar into the billions after shareholder losses, lawsuits, fines, and PR costs are added up. Still those aren’t the real reasons to focus on this, claims Haidt. The longer-term benefits to a world with greater ethical substance far outweigh the costs of cutting corners for short-term gains. Sadly, unethical choices have paid well for too many executives.

The article is here.

Sunday, February 7, 2016

Tolerable Risks? Physicians and Youth Tackle Football

Kathleen E. Bachynski, M.P.H.
N Engl J Med 2016; 374:405-407

At least 11 U.S. high-school athletes died playing football during the fall 2015 season. Their deaths attracted widespread media attention and provided fodder for ongoing debates over the safety of youth tackle football. In October 2015, the American Academy of Pediatrics (AAP) issued its first policy statement directly addressing tackling in football. The organization’s Council on Sports Medicine and Fitness conducted a review of the literature on tackling and football-related injuries and evaluated the potential effects of limiting or delaying tackling on injury risk. It found that concussions and catastrophic injuries are particularly associated with tackling and that eliminating tackling from football would probably reduce the incidence of concussions, severe injuries, catastrophic injuries, and overall injuries.

But rather than recommend that tackling be eliminated in youth football, the AAP committee primarily proposed enhancing adult supervision of the sport. It recommended that officials enforce the rules of the game, that coaches teach young players proper tackling techniques, that physical therapists and other specialists help players strengthen their neck muscles to prevent concussions, and that games and practices be supervised by certified athletic trainers. There is no systematic evidence that tackling techniques believed to be safer, such as the “heads-up” approach promoted by USA Football (amateur football’s national governing body), reduce the incidence of concussions in young athletes. Consequently, the AAP statement acknowledged the need for further study of these approaches. The policy statement also encouraged the expansion of nontackling leagues as another option for young players.

The article is here.

Thursday, February 4, 2016

French drug trial leaves one brain dead and five critically ill

By Angelique Chrisafis
The Guardian
Originally published January 15, 2916

Here is an excerpt:

Touraine said the study was a phase one clinical trial, in which healthy volunteers take the medication to “evaluate the safety of its use, tolerance and pharmacological profile of the molecule”.

Medical trials typically have three phases to assess a new drug or device for safety and effectiveness. Phase one entails a small group of volunteers and focuses only on safety. Phase two and three are progressively larger trials to assess the drug’s effectiveness, although safety remains paramount.

Testing had already been carried out on animals, including chimpanzees, starting in July, Touraine said.

Bial said it was committed to ensuring the wellbeing of test participants and was working with authorities to discover the cause of the injuries, adding that the clinical trial had been approved by French regulators.

The story is here.

Sunday, December 6, 2015

The Effects of Social Context and Acute Stress on Decision Making Under Uncertainty

Oriel FeldmanHall, Candace M. Raio, J. T. Kubota, M. G. Seiler,  & E. A. Phelps
Psychological Science, November 5, 2015
doi: 10.1177/0956797615605807

Abstract

Uncertainty preferences are typically studied in neutral, nonsocial contexts. This approach, however, fails to capture the dynamic factors that influence choices under uncertainty in the real world. Our goal was twofold: to test whether uncertainty valuation is similar across social and nonsocial contexts, and to investigate the effects of acute stress on uncertainty preferences. Subjects completed matched gambling and trust games following either a control or a stress manipulation. Those who were not under stress exhibited no differences between the amount of money gambled and the amount of money entrusted to partners. In comparison, stressed subjects gambled more money but entrusted less money to partners. We further found that irrespective of stress, subjects were highly attuned to irrelevant feedback in the nonsocial, gambling context, believing that every loss led to a greater chance of winning (the gamblers’ fallacy). However, when deciding to trust a stranger, control subjects behaved rationally, treating each new interaction as independent. Stress compromised this adaptive behavior, increasing sensitivity to irrelevant social feedback.

The entire article is here.

Monday, March 9, 2015

Debate heats up over safety of electronic health records

Jayne O'Donnell and Laura Ungar
USAToday
Originally posted February 3, 2015

Department of Health and Human Services officials said Tuesday that the safety benefits of electronic health records far outweigh any potential problems, but critics say regulators are pushing health care providers to use them while downplaying the risks to patients.

"This transition to electronic health records has led to far better safety than (it has) created new problems," said Andy Gettinger, an physician who heads health information technology (HIT) safety at HHS, at a government-sponsored conference here.

The entire article is here.

Sunday, November 30, 2014

Brain stimulation for ‘enhancement’ in children: An ethical analysis

By Hannah Maslen, Brian D Earp, Roi Cohen-Kadosh and Julian Savulescu
Frontiers in Human Neuroscience
Revised on November 6, 2014

Abstract

Davis (2014) called for "extreme caution" in the use of non-invasive brain stimulation (NIBS) to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child's future options. The distinction between treatment and enhancement has some normative force here. As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests (as judged by the parents) diminish, and the need to protect the child's (future) autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are (themselves) justified on a best interests standard.

The entire article is here.

Thursday, August 14, 2014

Bostrom on Superintelligence

By John Danaher
Philosophical Disquisitions
Originally published July 27, 2014

Nick Bostrom’s magnum opus on the topic of AI risk — Superintelligence: Paths, Dangers and Strategies — was recently published by Oxford University Press. The book is a comprehensive overview and analysis of the risks arising from an intelligence explosion. As you may know, some people are concerned that the creation of superintelligent machines will precipitate an existential catastrophe for the human race. For better or worse, the debate about this issue has largely taken place online, via various internet fora. Now, while I’m certainly not one to disparage such fora — this blog, after all, would count as one — I have to admit that Bostrom’s book is something of a relief. At last, we have a detailed, reasonably sober, academic analysis of the issue, one that is clearly the product of many years of research, reflection and discussion.

The rest of the review and content analysis is here.

Thursday, August 7, 2014

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.

Monday, May 5, 2014

In Medical Decisions, Dread Is Worse Than Fear

Procrastination, on the other hand, may not be so bad.

By Gabriella Rosen Kellerman
The Atlantic
Originally published April 15, 2014

Here is an excerpt:

One of the solutions Rosenberg proposed was “interventions aimed at improving risk communication.” Meaning that, perhaps if healthcare providers can help patients more rationally assess the risks for now versus later, they can help them avoid unnecessary suffering. To do so, providers will have to help patients address the assumptions that enable get-it-out-of-the-way decision-making.

What, for example, is the "it" in "get-it-out-of-the-way" thinking? The pain or consequence one wishes to avoid are often moving, even unknowable, targets. In pathological anxiety states, estimations of what “it” is are part of what goes awry. Patients with phobias consistently overestimate the degree of unpleasantness of a particular exposure.

The entire article is here.

Tuesday, April 29, 2014

This will hurt a bit

By David Hunter
BMJ Group Blogs
Originally posted April 11, 2014

Here is an excerpt:

In this piece she describes the case of a Cornell graduate student who carried out a piece of self-experimentation without IRB approval (based on the mistaken belief it wasn’t required) which aimed to assess which part of the body was worst to be stung by a bee on and involved:  ”five stings a day, always between 9 and 10am, and always starting and ending with “test stings” on his forearm to calibrate the ratings. He kept this up for 38 days, stinging himself three times each on 25 different body parts.”

The entire blog is here.

Thursday, August 22, 2013

Health, fitness apps pose HIPAA risks for doctors

Physicians should check apps’ privacy protections before suggesting them to patients. A new report says most apps — especially free ones — don’t offer much privacy.

By SUE TER MAAT
amednews.com
Posted Aug. 5, 2013

Physicians might think twice about advising patients to use some mobile health and fitness apps. A July report indicates that many of those apps compromise patients’ privacy. Just recommending apps may put doctors at risk for violations of the Health Insurance Portability and Accountability Act.

“Even suggesting an app to patients — that’s a gray area,” said Marion Neal, owner of HIPAASimple.com, a HIPAA consulting firm for physicians in private practice. “Doctors should avoid recommending apps unless they are well-established to be secure.”

The entire story is here.