Kierkegaard at 200

By Gordon Marino
The New York Times - Op Ed
Originally published May 3, 2013

THE intellectual immortal Soren Kierkegaard turns 200 on Sunday. The lyrical Danish philosopher is widely regarded as the father of existentialism, a philosophical and literary movement that emphasizes the category of the individual and meditates on such gauzy questions as, Is there a meaning to life?
      

Not surprisingly, existentialism hit its zenith after humanity got a good look at itself in the mirror of the Holocaust, but then memories faded and economies boomed and existentialism began to seem a little overwrought.

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In one of his books Kierkegaard moans, “The present age is an age of publicity, the age of miscellaneous announcements: Nothing happens but still there is instant publicity.” In the end, Kierkegaard was concerned about the power of the press to foment and form public opinion and in the process relieve of us of the need to think matters through on our own.

      

Over a 17-year span, Kierkegaard published a score of books and compiled thousand of pages of journal entries. Like Nietzsche and other geniuses who were more than less immolated by the fiery force of their own ideas, Kierkegaard sacrificed his body to dance out the riches of his thoughts. Self-conscious of his own preternatural powers, he wrote, “Geniuses are like thunderstorms. They go against the wind, terrify people, cleanse the air.”

The entire piece is here.

Vignette 25: A Questionable Letter

Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying.  During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats.  Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.

After this event, Mrs. Olson became more forthcoming with Dr. Frances.  His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors.  Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.

Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility.  Dr. Frances feels an anxiety reaction in her body.  Trying to calm down, Dr. Frances writes out a list of questions.

1.      Should I open the letter now (as it is addressed to me)?

2.      Should I tell the patient about the letter before I open it?

3.      What are the benefits of telling the patient about the letter?

4.      What are the drawbacks of telling the patient about the letter?

5.      If the letter contains threatening information toward Mrs. Olson, or me, am I able to turn the letter over to the District Attorney?

6.      Am I required to turn the letter over to the DA if there is threatening information in it?

7.      How much control does the patient have over the letter and its contents?

8.      Is the letter automatically part of the treatment record or does it depend on the contents of the letter?

9.      Do I need a self-care plan as I am stressed out about this situation?

Having calmed down and written out these questions, Dr. Frances calls you for an ethics consultation about the letter.

What are your responses to her questions about the letter?

Capitalism is killing our morals, our future

By Paul B. Farrell
The Wall Street Journal
Originally published April 29, 2013


Yes, capitalism is working ... for the Forbes 1,000 Global Billionaires whose ranks swelled from 322 in 2000 to 1,426 recently. Billionaires control the vast majority of the world’s wealth, while the income of American workers stagnated.

For the rest of the world, capitalism is not working: A billion live on less than two dollars a day. With global population exploding to 10 billion by 2050, that inequality gap will grow, fueling revolutions, wars, adding more billionaires and more folks surviving on two bucks a day.

Over the years we’ve explored the reasons capitalism blindly continues on its self-destructive path. Recently we found someone who brilliantly explains why free-market capitalism is destined to destroy the world, absent a historic paradigm shift: That is Harvard philosopher Michael Sandel, author of the new best-seller, “What Money Can’t Buy: The Moral Limits of Markets,” and his earlier classic, “Justice: What’s the Right Thing to Do?”

For more than three decades Sandel’s been explaining how capitalism is undermining America’s moral values and why most people are in denial of the impact. His classes are larger than a thousand although you can take his Harvard “Justice” course online. Sandel recently summarized his ideas about capitalism in the Atlantic. In “What Isn’t for Sale?” he writes:

“Without being fully aware of the shift, Americans have drifted from having a market economy to becoming a market society ... where almost everything is up for sale ... a way of life where market values seep into almost every sphere of life and sometimes crowd out or corrode important values, non-market values.”

Sandel should be required reading for all Wall Street insiders as well as America’s 95 million Main Street investors. Here’s a condensed version:

In one generation, market ideology consumed America’s collective spirit

“The years leading up to the financial crisis of 2008 were a heady time of market faith and deregulation — an era of market triumphalism,” says Sandel. “The era began in the early 1980s, when Ronald Reagan and Margaret Thatcher proclaimed their conviction that markets, not government, held the key to prosperity and freedom.”

And in the 1990s with the “market-friendly liberalism of Bill Clinton and Tony Blair, who moderated but consolidated the faith that markets are the primary means for achieving the public good.”

Today “almost everything can be bought and sold.” Today “markets, and market values, have come to govern our lives as never before. We did not arrive at this condition through any deliberate choice. It is almost as if it came upon us,” says Sandel.

The entire article is here.

You can find Harvard University's Justice with Michael Sandel here.

Schools drop Mellow’s name

By Andrew Seder
The Times Leader
Originally published April 25, 2013

The name of disgraced ex-state Sen. Robert J. Mellow has been removed from two buildings, a portion of one local college campus and one park.

On Thursday, Marywood University issued a statement saying, “After thoughtful consideration, The Marywood University Board of Trustees made the decision this past Saturday at their spring meeting to rename the university’s athletic center. The center originally named for Senator Robert J. Mellow, will for the foreseeable future be referred to as The Marywood University Center for Athletics and Wellness.”

Also, Lackawanna College President Mark Volk sent an email to all college staff members Thursday informing them that the campus’ Mellow Theater has been renamed.

“The college’s board of trustees met recently and after a serious discussion decided to name the college’s theater. Effective immediately, it is officially The Theater at Lackawanna College,” Volk wrote in the email obtained by The Times Leader.

The entire story is here.

Physicians build less rapport with obese patients

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective: 
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods: 
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results: 
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.

Genetic Testing Recommendations Contradict Professional Ethics, Experts Say

By Rebecca Voelker
News@JAMA
Originally posted May 9, 2013

Recent recommendations that advise laboratories and physicians how to tell patients about incidental findings in genetic tests contradict ethical clinical practice, according to bioethicists at Stanford University’s Center for Biomedical Ethics in California.

A working group convened by the American College of Medical Genetics and Genomics (ACMG) released recommendations in March saying that clinical DNA sequencing laboratories should test for a list of specific genetic abnormalities regardless of the clinical reason for testing and report the results to the patient’s physician. In turn, the recommendations say physicians have a responsibility to give patients all the findings, even if patients don’t want results that aren’t relevant to the condition for which they were tested.

The ACMG recommends that patients who undergo genome sequencing be tested for conditions including various forms of cancer, cardiomyopathy, and familial hypercholesterolemia in addition to their primary medical condition.

Recommending that patients not be able to choose whether they want to receive incidental findings, even when test results suggest adult-onset conditions in children, “contradicts ethical clinical practice in general,” wrote bioethicists Megan Allyse, PhD, and Marsha Michie, PhD, in the journal Trends in Biotechnology.

The entire article is here.

The ACMG recommendations are here.

The Mind of a Con Man

By YUDHIJIT BHATTACHARJEE
The New York Times
Published: April 26, 2013

Here are some excerpts:

Stapel was an academic star in the Netherlands and abroad, the author of several well-regarded studies on human attitudes and behavior. That spring, he published a widely publicized study in Science about an experiment done at the Utrecht train station showing that a trash-filled environment tended to bring out racist tendencies in individuals. And just days earlier, he received more media attention for a study indicating that eating meat made people selfish and less social.

His enemies were targeting him because of changes he initiated as dean, Stapel replied, quoting a Dutch proverb about high trees catching a lot of wind. When Zeelenberg challenged him with specifics — to explain why certain facts and figures he reported in different studies appeared to be identical — Stapel promised to be more careful in the future. As Zeelenberg pressed him, Stapel grew increasingly agitated.

Finally, Zeelenberg said: “I have to ask you if you’re faking data.”

“No, that’s ridiculous,” Stapel replied. “Of course not.”

That weekend, Zeelenberg relayed the allegations to the university rector, a law professor named Philip Eijlander, who often played tennis with Stapel. After a brief meeting on Sunday, Eijlander invited Stapel to come by his house on Tuesday morning. Sitting in Eijlander’s living room, Stapel mounted what Eijlander described to me as a spirited defense, highlighting his work as dean and characterizing his research methods as unusual. The conversation lasted about five hours. Then Eijlander politely escorted Stapel to the door but made it plain that he was not convinced of Stapel’s innocence.

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And yet as part of a graduate seminar he taught on research ethics, Stapel would ask his students to dig back into their own research and look for things that might have been unethical. “They got back with terrible lapses­,” he told me. “No informed consent, no debriefing of subjects, then of course in data analysis, looking only at some data and not all the data.” He didn’t see the same problems in his own work, he said, because there were no real data to contend with.

The entire story is here.

Conversion therapy advocate issues formal apology, renounces “ex-gay” past

John Paulk says in a statement that he was never "cured" of being gay and apologizes for harming the LGBT community

BY KATIE MCDONOUGH
Salon.com
Originally posted April 25, 2013

Former Exodus International chairman and conversion therapy “success story” John Paulk has written a formal statement of apology for his role in promoting Focus on the Family’s “ex-gay” ministry and for any harm his actions may have done to other gays and lesbians.

In the letter, Paulk admits that “many things” in his life changed during his time at Focus on the Family, though his sexual orientation did not.

The entire letter of apology can be found here.

Here are some excerpts:

"So in 2003, I left the public ministry and gave up my role as a spokesman for the “ex-gay movement.” I began a new journey. In the decade since, my beliefs have changed. Today, I do not consider myself “ex-gay” and I no longer support or promote the movement. Please allow me to be clear: I do not believe that reparative therapy changes sexual orientation; in fact, it does great harm to many people.

I  know that countless people were harmed by things I said and did in the past.

Parents, families, and their loved ones were negatively impacted by the notion of reparative therapy and the message of change. I am truly, truly sorry for the pain I have caused."

The Salon story is here.

Poor Prognosis for Privacy

By Melinda Beck
The Wall Street Journal
Originally published May 1, 2013

The sharing of Americans' health information is set to explode in coming years, with millions of patients' medical records converted to electronic form and analyzed by health-care providers, insurers, regulators and researchers.

That has prompted concerns over privacy—and now, new federal rules that aim to give patients more control over their information are posing technical and administrative problems for the doctors and hospitals that have to implement them.

Information-technology experts say the challenges illustrate how difficult it may be to protect sensitive patient information as digitization of the health-care industry expands.

"The reality is, our ability to exchange electronic information is already well beyond our ability to control it," says John Leipold, CEO of Valley Hope Technology in Norton, Kan., which makes electronic record systems for behavioral-health providers.

The new rules are part of a revision of the 1996 Health Insurance Portability and Accountability Act, known as HIPAA. They went into effect in March, but providers have until Sept. 23 to comply.

One key new provision requires doctors and hospitals not to disclose medical information to a patient's insurer if the patient requests it and pays for the services out-of-pocket. The information can be noted in the patient's medical file, but stopping it being revealed to insurers inadvertently may be difficult, some health-care providers say.

The entire story is here.

You will likely hit a pay-wall for this story.