Can Doctors Learn Empathy?

By Pauline W. Chen, MD
The New York Times - Well
Originally published June 21, 2012

Empathy has always been considered an essential component of compassionate care, and recent research has shown that its benefits go far beyond the exam room. Greater physician empathy has been associated with fewer medical errors, better patient outcomes and more satisfied patients. It also results in fewer malpractice claims and happier doctors.

A growing number of professional accrediting and licensing agencies have taken these findings to heart, developing requirements that make empathy a core value and an absolute “learning objective” for all doctors. But even for the most enthusiastic supporters of such initiatives, the vexing question remains: Can people learn to be empathetic?

A new study reveals that they can.

The entire story is here.

More transparency into government requests

By Dorothy Chou

Google Senior Policy Analyst

Originally posted June 17, 2012

About two years ago, we launched our interactive Transparency Report. We started by disclosing data about government requests. Since then, we’ve been steadily adding new features, like graphs showing traffic patterns and disruptions to Google services from different countries. And just a couple weeks ago, we launched a new section showing the requests we get from copyright holders to remove search results.

(cut)

This is the fifth data set that we’ve released. And just like every other time before, we’ve been asked to take down political speech. It’s alarming not only because free expression is at risk, but because some of these requests come from countries you might not suspect—Western democracies not typically associated with censorship.

(cut)

We’ve rounded up some additional interesting facts in the annotations section of the Transparency Report. We realize that the numbers we share can only provide a small window into what’s happening on the web at large. But we do hope that by being transparent about these government requests, we can continue to contribute to the public debate about how government behaviors are shaping our web.

The entire blog post is here.

Thanks to Ed Zuckerman for this lead.

Affordable Health Care's Individual Mandate ruled Constitutional

By Lynn Sweet and Dave McKinney
Chicago Sun Times

In an historic decision, the U.S. Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama’s health care overhaul.

The decision means the overhaul will continue to go into effect over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Chief Justice John Roberts announced the court’s judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

The court found problems with the law’s expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states’ entire Medicaid allotment if they don’t take part in the law’s extension.

The court’s four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

 

The entire story is here.

Catastrophic neglect of basic sciences in medicine

The Lancet, Volume 379, Issue 9833, Pages 2239 - 2240, 16 June 2012
By Saroj Jayasinghe

Here is a portion of the correspondence.

Inappropriate attention to basic sciences could also unduly delay implementation of such simple interventions, resulting in unnecessary death and suffering. The conceit is not that “epidemiology is the basic science of clinical medicine”. The real conceit is to believe that health issues are mainly solved by basic scientists and health professionals. The truth, although unpalatable to some, is that health-related problems are mostly the result of the social and physical environment during our life course.....

The entire letter is here.

Catastrophic neglect of the basic sciences in medicine

The Lancet, Volume 379, Issue 9823, Page 1273, 7 April 2012

Talk with scientists who work in research-intensive schools of medicine and you hear a resonant message. The basic medical sciences are not only being neglected, they are being systematically eroded. This marginalisation will have damaging effects on clinical care over the next two decades. The foundations of fundamental knowledge about health will be fractured. The platform for applied research will have atrophied. Patient care will be harmed by the prevailing short-sighted and expedient approach to discovery science.

(cut)

The errors seem to be multiple. Project grants—3-year investments of modest sums (£300 000) into the careers of young scientists—have withered. Scientists tell us that this dramatic shift in policy—converting our funding bodies into versions of the Howard Hughes Medical Institute—is a laudable objective, but one with unanticipated negative consequences. Not the least of which is the excision of investment into future generations of young medical researchers. Such a perilous policy, pursued by some research councils and larger charities alike, is being driven by a political environment that emphasises big science and aggresive commercial returns on research investments.

The entire article is here.

Carnegie Mellon Researchers Find Physicians Are Biased When Evaluating Medical Conflict of Interest Policies

Same Patterns Found in Finance Industry; Researchers Suggest Need For Third Parties in Conflict of Interest Policy-Making Process

Carnegie Mellon Press Release
Originally published on June 19, 2012

Medical institutions have been under pressure to develop and implement policies to avoid conflicts of interest between physicians and pharmaceutical companies. In most cases, medical professionals who have a stake in the issues at hand craft the conflict of interest policies.

New research from Carnegie Mellon University's George Loewenstein and Zachariah Sharek and the University of Pittsburgh's Robert Schoen investigated whether medical professionals making conflict of interest policy decisions are able to separate their policy judgments from their personal, vested interests. The research, which will be published in an upcoming issue of the Journal of Law, Medicine and Ethics, shows that physicians are subject to motivated bias when it comes to assessing the policies intended to regulate their behavior. The research team also tested financial planners and found similar stronger patterns of motivated bias.

(cut)

Finally, the control group with no vested interest evaluated both policies positively, and dismissed the objections as being unreasonable.

The entire press release is here.

Why (Almost) All of Us Cheat and Steal

Behavioral economist Dan Ariely talks about why everyone's willing to cheat a little, why you'll steal a staple from work but not petty cash and whether punishments for cheating actually work

By Gary Belsky

Time Magazine - Business

Originally published June 18, 2012

Behavioral economist Dan Ariely, who teaches at Duke University, is known as one of the most original designers of experiments in social science. Not surprisingly, the best-selling author’s creativity is evident throughout his latest book, The (Honest) Truth About Dishonesty. A lively tour through the impulses that cause many of us to cheat, the book offers especially keen insights into the ways in which we cut corners while still thinking of ourselves as moral people. Here, in Ariely’s own words, are seven lessons you didn’t learn in school about dishonesty. (Interview edited and condensed by Gary Belsky.)

1. Most of us are 98-percenters.

“A student told me a story about a locksmith he met when he locked himself out of the house. This student was amazed at how easily the locksmith picked his lock, but the locksmith explained that locks were really there to keep honest people from stealing. His view was that 1% of people would never steal, another 1% would always try to steal, and the rest of us are honest as long as we’re not easily tempted. Locks remove temptation for most people. And that’s good, because in our research over many years, we’ve found that everybody has the capacity to be dishonest and almost everybody is at some point or another.”

The entire story is here.

Mapping Your End-of-Life Choices

By Jane E. Brody
The New York Times - Well
Originally published June 18, 2012

Here is an excerpt:

“People need to sit down and decide what kind of care makes sense to them and what doesn’t make sense, and who would be the best person to represent them if they became very ill and couldn’t make medical decisions for themselves,” Dr. Hammes said.

“If, for example, you had a sudden and permanent brain injury, how bad would that injury have to be for you to say that you would not want to be kept alive? What strongly held beliefs and values would influence your choice of medical treatment?”

Divisive family conflicts and unwanted medical interventions can be avoided when people specify their wishes, he said. His own mother “told us that if she had severe dementia, it would be a total waste of her life savings to keep her alive. She would rather that her children got the money.”

“We help people work through the decision process and involve those close to them so that the family shares in their goals,” Dr. Hammes said. “When patients have a care plan, the moral dilemmas doctors face can be prevented.”

At Good Medicine in San Francisco, Dr. Brokaw and her colleagues have thus far helped about two dozen people explain their goals and preferences, at a cost of $1,500 for each person.

The entire article is here.

Getting Fat and Fatter

By Kim McPherson
The Lancet
doi:10.1016/S0140-6736(12)60966-0

Book Review
Fat Fate and Disease: Why Exercise and Diet Are Not Enough
By Peter Gluckman and Mark Hanson
Oxford University Press

"We need a public debate about what it means to keep markets in their place. And to have this debate, we have to think through the moral limits of markets. We need to recognise that there are some things that money can't buy and other things that money can buy but shouldn't."

Michael Sandel, “Market and Morals”

We live in a world where it is increasingly apparent that markets have all sorts of unwanted consequences, but they remain the bedrock of our civilisation. That we should relentlessly pursue economic growth is unquestioned, while the planet is drying up and we are becoming increasingly obese. And by a dominant political account the way to grow is to liberate the markets wherever we can. Thus the planet nears extinction more quickly and the prevalence of type 2 diabetes increases alarmingly across the globe. So is some kind of consensual good will required, as Michael Sandel suggested in his 2009 Reith Lecture?

(cut)

We have yet to discover an acceptable way to make markets properly balance all the pay-offs caused by unhealthy production, one of which is to suffer loss at the point of production commensurate with the harm of causing bad health in the longer term. We are not even close. Good will and responsible citizenship are not, I suspect, going to solve this problem simply because profit and growth trump everything.

The entire review and commentary are here.