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

Monday, April 2, 2012

Sandusky Case: Man who evaluated alleged victim was not yet psychologist

By Mike DawsonCentredaily.com
Originally published March 28, 2012

Dr. Morford
After State College psychologist Alycia Chambers talked to an 11-year-old boy about Jerry Sandusky showering with him in May 1998, she concluded Sandusky was exhibiting signs of grooming the boy for sexual abuse.

A couple days later, a counselor, John Seasock, met with the boy and had a different conclusion. The showering episode, Seasock determined, was rather the result of a routine that coaches like Sandusky do after a workout.

Centre County prosecutors did not pursue criminal charges against Sandusky after that incident, and whether the competing conclusions factored into that decision remains a subject of conjecture.

But, almost 14 years later, the fact that Seasock wasn’t a psychologist at the time, according to state records, raises questions about how much weight his opinion should have carried.

“To take that person’s word over a psychologist who has been prepared and licensed by the state is, I would say, very surprising and a serious concern,” said Marolyn Morford, a State College psychologist.

Morford said Tuesday she’s been alarmed by Seasock’s representation as a psychologist at the time in question. That’s how the Penn State police investigation report refers to him, and that’s how Seasock has been referred to in media reports after the document was leaked Saturday.

State records show that Seasock has been licensed as a professional counselor since January 2002.

The entire story is here.

Dr. Morford is a member of PPA's Ethics Committee.

Sunday, April 1, 2012

Self-Care Practices and Perceived Stress Levels Among Psychology Graduate Students

By Shannon B. Myers , Alison C. Sweeney, Victoria Popick, Kimberly Wesley, Amanda Bordfeld, & Randy Fingerhut
Training and Education in Professional Psychology, Vol 6(1), February 2012, pp 55-66.

Stress has been defined as the perception that the demands of an external situation are beyond one's perceived ability to cope (Lazarus, 1966).

DeAngelis (2002) suggests that psychologists are particularly vulnerable to stress and that, while they promote self-care practice and stress management with clients, psychologists rarely heed their own advice.

Psychology graduate students are also vulnerable to stress because of the multiple demands of graduate school including academic coursework, research, clinical training, and financial constraints.

Stress related to performance anxiety, competition, institutional demands, lack of experience, and interpersonal/professional relationships has been noted in this population (Badali & Habra, 2003).

Furthermore, psychology graduate students represent a unique population who must navigate these stressors and their new roles, while simultaneously developing the knowledge and skills necessary to provide clinical and therapeutic services to others.

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Discussion

The current study suggests that self-care practices are related to perceived stress levels among psychology graduate students across the United States. There were also some differences based on demographic factors. Age, relationship status, and sufficiency of income to cost of living were significantly related to perceived stress levels. Psychology graduate students who indicated that their household income was insufficient compared with their cost of living perceived more stress, which is consistent with previous research suggesting a reciprocal relationship between perceived stress and financial satisfaction in adult students (Sandler, 2000). Married students also reported significantly less stress than their nonmarried counterparts. This pattern has emerged in previous research in which psychology graduate students who were not in a committed relationship reported the highest levels of stress (Hudson & O'Regan, 1994). Marriage can provide a strong source of relational support, which has been linked to lower levels of stress in students (Craddock, 1996). Finally, age significantly predicted perceived stress levels, in that the older students reported less perceived stress. Previous research has suggested that older individuals report fewer daily hassles than their younger counterparts possibly as a result of the development of alternative coping strategies (Folkman, Lazarus, Pimley, & Novacek, 1987). Older students may have developed more effective ways to cope with the competing demands of graduate school and therefore perceive less stress.

The entire article is here.

The author note provides the following contact information for reprint requests, questions, and comments: Shannon B. Myers, The Cancer Institute of New Jersey-UMDNJ, 195 Little Albany Avenue, New Brunswick, NJ 08901; Email: shmyers1@hotmail.com.

Thanks to Ken Pope for this information.

Dr. Fingerhut is a member of the Ethics Committee.

Saturday, March 31, 2012

Here’s why health insurance is not like broccoli

By Ezekiel Emanuel
The Great Debate - Reuters
Originally published March 29, 2012

The fate of universal healthcare coverage that the United States has been trying to achieve for over 100 years may boil down to broccoli.

The broccoli argument is simple and was frequently referred to in the recent Supreme Court arguments: If the government can require people to buy health insurance, why couldn’t it require people to buy broccoli, which also enhances people’s health? This question, at the heart of the conservative objection to the individual mandate to buy health insurance, illustrates the so-called limiting principle the Supreme Court must rule on: Under the Commerce Clause, does Congress have the constitutional power to compel people to act, in ways they might object to, when their inaction can harm others?

The High Court never got clear on why health insurance is not like broccoli and can thus be constitutionally regulated. There are two important differences that inform the principle for limiting congressional power to compel people to purchase goods and services.

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The difference between broccoli and health insurance is simple. It leads to a clear limiting principle. Congress can urge people to eat their broccoli, but not compel them to buy it, because the broccoli market will function regardless of what people do. Congress can compel people to buy their health insurance because otherwise there will be no health insurance market.

The entire story is here.

Doctors' Smartphones And iPads May Be Distracting

By Jenny Gold
Kaiser Health News
This story was produced in collaboration with NPR
Originally published on March 26, 2012

Dr. Henry Feldman is a mobile technology evangelist. He struts boldly around Beth Israel Deaconess Medical Center, where he works as a hospitalist and programmer, armed with an iPhone and iPad. His nickname is the iDoctor.

Mobile technology, he argues, has made him a better, faster physician. "It lets me do everything I could do if I was sitting at my desktop at the patient's bedside, and actually some things I couldn't easily do," he explains enthusiastically. That includes showing patients impressive new animated apps, diagrams, medical records and even photos from their own surgeries as they recover. 

Beth Israel, a teaching hospital for Harvard Medical School, is one of the most technically advanced hospitals in the country, especially when it comes to mobile technology.

But not everyone at the hospital is quite as gung-ho as Feldman. Recently, Dr. John Halamka, the hospital's chief information officer who helped usher Beth Israel into the electronic world, has been issuing a warning: mobile technology also has a serious downside—it may distract doctors from patient care.

The entire story is here.

Friday, March 30, 2012

Suicides Highlight Failures of Veterans' Support System

By Aaron Glanz
The New York Times
Originally published March 24, 2012

Francis Guilfoyle, a 55-year-old homeless veteran, drove his 1985 Toyota Camry to the Department of Veterans Affairs campus in Menlo Park early in the morning of Dec. 3, took a stepladder and a rope out of the car, threw the rope over a tree limb and hanged himself.

It was an hour before his body was cut down, according to the county coroner's report.

"When I saw him, my heart just sank," said Dennis Robinson, 51, a formerly homeless Army veteran who discovered Mr. Guilfoyle's body.

"This is supposed to be a safe place where a vet can get help. Something failed him."

Mr. Guilfoyle's death is one of a series of recent suicides by veterans who live in the jurisdiction of the Department of Veterans Affairs Palo Alto Health Care System.

The Palo Alto V.A. is one of the agency's elite campuses, home to the Congressionally chartered National Center for Post-Traumatic Stress Disorder.

The poor record of the Department of Veterans Affairs in decreasing the high suicide rate of veterans has already emerged as a major issue for policy makers and the judiciary.

On Wednesday, the V.A. Inspector General in Washington released the results of a nine-month investigation into the May 2010 death of another veteran, William Hamilton.

The report said social workers at the department in Palo Alto made "no attempt" to ensure that Hamilton, a mentally ill 26-year-old who served in Iraq, was hospitalized at a department facility in the days before he killed himself by stepping in front of a train in Modesto.

The story is here.

Military-Funded Brain Science Sparks Controversy

By Charles Choi
InnovationNewsDaily
Originally published March 20, 2012

Brain research and associated advances such as brain-machine interfaces that are funded by the U.S. military and intelligence communities raise profound ethical concerns, caution researchers who cite the potentially lethal applications of such work and other consequences.

Rapid advances in neuroscience made over the last decade have many dual-use applications of both military and civilian interest. Researchers who receive military funding — with the U.S. Department of Defense spending more than $350 million on neuroscience in 2011 — may not fully realize how dangerous their work might be, say scientists in an essay published online today (March 20) in the open-access journal PLoS Biology.

Thursday, March 29, 2012

Preventing Suicide on Campus May Mean Fences and Nets as Well as Counseling


Chronicle of Higher Education
By Michael Stratford
Originally published March 25, 2012

The families of students who die by suicide often seek to hold colleges responsible.

Lawsuits typically claim that an institution failed to pick up on warning signs or to adequately protect a student whom campus officials knew to be suicidal.

Far less often does a legal action cite, say, the absence of fences on a bridge.

But a lawsuit now pending against Cornell University in federal court takes that approach: It argues that the institution didn't do enough to restrict access to a particular means of suicide.

Specifically, Howard I. Ginsburg alleges that Cornell was negligent for not having installed barriers on the campus bridge where, in February 2010, his son, Bradley, jumped to his death.

A judge this month rejected the university's effort to have the suit dismissed, ruling that the case could continue.

Limiting access to certain methods of suicide, a strategy known as means restriction, has been gaining traction among mental-health researchers.

Some suicides can be prevented, the logic goes, if it's more challenging for an impulsive individual to harm himself.

But on most campuses, that strategy has not taken hold.

 Instead, counseling and education tend to be the centerpiece of suicide-prevention efforts.

 Only at a few institutions, mainly where students' suicides have made headlines in recent years--like Cornell, New York University, and the Massachusetts Institute of Technology--have administrators acted, beyond locking doors to roofs, to significantly alter physical elements of the campus in the name of prevention.

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For not taking steps to block bridge suicides, the lawsuit says, both Cornell and the city were "negligent, careless, and reckless in failing to provide for safety and protection for vulnerable or impulsive individuals."

University and city officials, Mr. Ginsburg argues, knew that area bridges were a recurring site of suicides and therefore had an obligation to restrict access to them.

Cornell says it is "vigorously" fighting the suit, which Mr. Ginsburg filed in November.


A subscription to Chronicle of Higher Education is needed for the full article.

Thanks to Ken Pope for this information.


Counseling Conflict

By Allie Grasgreen
Inside Higher Ed
Originally published March 26, 2012

Georgia State University’s decision this month to replace its counseling center staff with outsourced employees is worrying those in the field, who say such moves are extremely rare and will likely prove detrimental to the mental health services available to students.

The shift is doubly troubling because a number of former staff members (as well as others in the field) are accusing the university of outsourcing services as a retaliation for their complaints that some university policies involving the counseling center had the potential to hurt students. While the outsourcing was announced shortly after the complaints were made, the university says there was no relationship between the two developments. The director and two associate directors will stay on as full-time employees of Georgia State, spokeswoman Andrea Jones said.

The university says it replaced its nine counseling center clinical positions (three of which were vacant) with contracted employees “in order to increase institutional effectiveness in delivering mental health services to students.”

Because the staff were eliminated through a “reduction in force” process, which is done without regard to an employee’s performance, the change could not have been retaliatory, Jones said. The new model will mimic that of Georgia State’s psychiatry services and health center (both of which commonly use independent contractors).

The entire story is here.

Wednesday, March 28, 2012

Publication Bias Mars Psychiatric Drug Literature

By John Gever, Senior Editor
MedPage Today
Originally Published March 23, 2012

Several negative studies of second-generation antipsychotic drugs were never published, leading to an exaggerated portrayal of the agents' effectiveness in the scientific literature, researchers said.

Of 24 registration trials involving eight products submitted to the FDA, four went unpublished in medical journals -- three of which found that the study drug's efficacy was equivalent to placebo or inferior to an active comparator, according to Erick H. Turner, MD, of Oregon Health and Science University in Portland, and colleagues.

Moreover, five of the 20 published trials "showed some evidence of outcome reporting bias," the researchers wrote online in PLoS Medicine.

Turner and colleagues also noted that the scale of the publication bias was relatively modest -- exaggerating the drugs' effectiveness relative to placebo or active comparators by a nonsignificant 8%. The weighted-average effect size in the published trials was 0.47 (95% CI 0.40 to 0.54), which declined only to 0.44 (95% CI 0.37 to 0.50) when the unpublished trials were included.


The research paper is below

Publication Bias in Antipsychotic Trials