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

Sunday, July 1, 2012

Suicide in young men

The Lancet, Volume 379, Issue 9834, Pages 2383 - 2392, 23 June 2012
doi:10.1016/S0140-6736(12)60731-4
By A. Pitman, K. Krysinska, D. Osborn, and M. King.

Summary

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.


Means restriction for suicide prevention

The Lancet, Volume 379, Issue 9834, Pages 2393 - 2399, 23 June 2012
doi:10.1016/S0140-6736(12)60521-2
By Yip, et. al

Summary

Limitation of access to lethal methods used for suicide—so-called means restriction—is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.



Self-harm and suicide in adolescents

The Lancet, Volume 379, Issue 9834, Pages 2373 - 2382, 23 June 2012
by K. Hawton, K. Saunders, and R. O'Connor
Originally published June 23, 2012

Summary

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.

Saturday, June 30, 2012

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.

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?

new study reveals that they can.

Friday, June 29, 2012

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.

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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.

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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.


Thanks to Ed Zuckerman for this lead.

Thursday, June 28, 2012

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.
 

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.

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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.

Tuesday, June 26, 2012

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.

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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.