A psychologist who completes evaluations for the Bureau of Disability Determination (BDD) calls you for a consultation.
Earlier in the day, the psychologist evaluated a 48-year-old male with a history of chronic pain. The only documentation received from BDD was a list of medications, which included an antidepressant and a prescription sleep aid.
The disability applicant arrived late for the evaluation, reporting that his pain prevented him from being on time. He shuffled his feet, walked in a hunched manner, used a cane, shifted in his seat frequently, and groaned throughout the evaluation. He described rather significant cognitive and vegetative symptoms of depression. He began to cry softly at one point when discussing the negative consequences of chronic pain. When asked about outpatient psychological treatment, the disability applicant explained he did not know that psychotherapy could help, and he would be anxious to try therapy.
At the end of the evaluation, the patient left, shuffling and making muffled groans as he left the office and the waiting room. When the psychologist returned to his office, he remembered a lunch date for which he was late. As he was leaving the office building, the psychologist saw the disability applicant in the parking lot laughing with another person. He twirled his cane with one hand. He stood upright and seemed genuinely happy. When the disability applicant met the psychologist’s gaze, the applicant immediately hunched over, grabbed his back, groaned loudly, and used the cane to steady himself. The psychologist hopped in his car for lunch without any discussion with the applicant.
Knowing that BDD evaluations are used within a legal context (in that lawyers, other psychologists, and administrative law judges will see this report), the psychologist asks the following questions:
1. What are the psychologist's ethical duties to the BDD?
2. What are the psychologist's ethical duties to the applicant?
3. Is the psychologist permitted to use any of his observations outside of the office as part of his report? If so, why? If not, why not?
4. If so, should it be included as an addendum or as part of the body of the report?
5. In either case, how do these observations influence the psychologist’s rating of truthfulness or veracity during the evaluation?
6. Does the psychologist have any obligation to clarify what happened in the parking lot with the disability applicant by phone?
7. If not, how should the psychologist respond if the disability applicant calls him to discuss the evaluation or the interaction in the parking lot?
8. Is it appropriate to use the term “malingering” in the report, given that there is such a small sample of behavior?
Monday, September 9, 2013
Is Individuality the Savior of Eugenics?
By Nathaniel Comfort
Scientific American Blog
Originally published August 23, 2013
Is eugenics a historical evil poised for a comeback? Or is it a noble but oft-abused concept, finally being done correctly?
Once defined as “the science of human improvement through better breeding,” eugenics has roared back into the headlines in recent weeks in both Mr. Hyde and Dr. Jekyll personae. The close observer may well wonder which will prevail. The snarling Mr. Hyde is the state control over reproduction. Although this idea may evoke visions of Nazi genocide, the U.S. itself has a long, unsavory eugenic history, peaking between 1910 and the mid-thirties but tailing out through the 20th century. And now into the 21st: the recent investigation by the Center for Investigative Reporting, which showed that between 2006 and 2010 nearly 150 pregnant prisoners had been sterilized against their will in California, was a stunning reminder that traces of the old eugenics remain in our own time.
The entire blog post is here.
Scientific American Blog
Originally published August 23, 2013
Is eugenics a historical evil poised for a comeback? Or is it a noble but oft-abused concept, finally being done correctly?
Once defined as “the science of human improvement through better breeding,” eugenics has roared back into the headlines in recent weeks in both Mr. Hyde and Dr. Jekyll personae. The close observer may well wonder which will prevail. The snarling Mr. Hyde is the state control over reproduction. Although this idea may evoke visions of Nazi genocide, the U.S. itself has a long, unsavory eugenic history, peaking between 1910 and the mid-thirties but tailing out through the 20th century. And now into the 21st: the recent investigation by the Center for Investigative Reporting, which showed that between 2006 and 2010 nearly 150 pregnant prisoners had been sterilized against their will in California, was a stunning reminder that traces of the old eugenics remain in our own time.
The entire blog post is here.
Sunday, September 8, 2013
3 Ways To Save Psychotherapy
People have been turning away from psychotherapy in favor of medication for years, despite the evidence that therapy works. Here are a few tips for improving the industry's image.
By Shaunacy Ferro
www.popsi.com
Posted 08.21.2013
The subtle art of lying on a therapist's couch is in rapid decline. Psychotherapy, the traditional one-on-one weekly session with a therapist, has been on the downswing for years, as more and more psychiatrists and even primary care doctors prescribe psychotropic medications instead of therapy. As the graphic above illustrates, between 1998 and 2007, psychotherapy use for people being treated for mental health conditions in the U.S. decreased from almost 16 percent to 10.5 percent, and therapy use in conjunction with medication went from 40 percent to 32 percent. By contrast, usage rates of medication alone shot up from 41 percent to a little more than 57 percent.
The entire story is here.
By Shaunacy Ferro
www.popsi.com
Posted 08.21.2013
The subtle art of lying on a therapist's couch is in rapid decline. Psychotherapy, the traditional one-on-one weekly session with a therapist, has been on the downswing for years, as more and more psychiatrists and even primary care doctors prescribe psychotropic medications instead of therapy. As the graphic above illustrates, between 1998 and 2007, psychotherapy use for people being treated for mental health conditions in the U.S. decreased from almost 16 percent to 10.5 percent, and therapy use in conjunction with medication went from 40 percent to 32 percent. By contrast, usage rates of medication alone shot up from 41 percent to a little more than 57 percent.
The entire story is here.
The reality show: The Truman Show Delusion
Schizophrenics used to see demons and spirits. Now they talk about actors and hidden cameras – and make a lot of sense
By Mike Jay
Aeon Magazine
Here is an excerpt:
The Gold brothers’ interpretation of the Truman Show delusion runs along similar lines. It might appear to be a new phenomenon that has emerged in response to our hypermodern media culture, but is in fact a familiar condition given a modern makeover. They make a primary distinction between the content of delusions, which is spectacularly varied and imaginative, and the basic forms of delusion, which they characterise as ‘both universal and rather small in number’.
Persecutory delusions, for example, can be found throughout history and across cultures; but within this category a desert nomad is more likely to believe that he is being buried alive in sand by a djinn, and an urban American that he has been implanted with a microchip and is being monitored by the CIA. ‘For an illness that is often characterised as a break with reality,’ they observe, ‘psychosis keeps remarkably up to date.’ Rather than being estranged from the culture around them, psychotic subjects can be seen as consumed by it: unable to establish the boundaries of the self, they are at the mercy of their often heightened sensitivity to social threats.
The entire article is here.
By Mike Jay
Aeon Magazine
Here is an excerpt:
The Gold brothers’ interpretation of the Truman Show delusion runs along similar lines. It might appear to be a new phenomenon that has emerged in response to our hypermodern media culture, but is in fact a familiar condition given a modern makeover. They make a primary distinction between the content of delusions, which is spectacularly varied and imaginative, and the basic forms of delusion, which they characterise as ‘both universal and rather small in number’.
Persecutory delusions, for example, can be found throughout history and across cultures; but within this category a desert nomad is more likely to believe that he is being buried alive in sand by a djinn, and an urban American that he has been implanted with a microchip and is being monitored by the CIA. ‘For an illness that is often characterised as a break with reality,’ they observe, ‘psychosis keeps remarkably up to date.’ Rather than being estranged from the culture around them, psychotic subjects can be seen as consumed by it: unable to establish the boundaries of the self, they are at the mercy of their often heightened sensitivity to social threats.
The entire article is here.
Saturday, September 7, 2013
Institutional Corruption and Pharmaceutical Policy
Institutional Corruption and Pharmaceutical Policy
An Edmond J. Safra Center Symposium
(forthcoming)
Journal of Law, Medicine and Ethics
Vol. 14, No. 3 (2013)
The goals of pharmaceutical policy and medical practice are often undermined due to institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or integrity. The pharmaceutical industry’s own purposes are often undermined. In addition, pharmaceutical industry funding of election campaigns and lobbying skews the legislative process that sets pharmaceutical policy. Moreover, certain practices have corrupted medical research, the production of medical knowledge, the practice of medicine, drug safety, and the Food and Drug Administration’s oversight of pharmaceutical marketing.
As a result, practitioners may think they are using reliable information to engage in sound medical practice while actually relying on misleading information and therefore prescribe drugs that are unnecessary or harmful to patients, or more costly than equivalent medications. At the same time, patients and the public may believe that patient advocacy organizations effectively represent their interests while these organizations actually neglect their interests.
The entire journal is here.
The articles are organized into five topics: (1) systemic problems, (2) medical research, (3) medical knowledge and practice, (4) marketing, and (5) patient advocacy organizations.
An Edmond J. Safra Center Symposium
(forthcoming)
Journal of Law, Medicine and Ethics
Vol. 14, No. 3 (2013)
The goals of pharmaceutical policy and medical practice are often undermined due to institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or integrity. The pharmaceutical industry’s own purposes are often undermined. In addition, pharmaceutical industry funding of election campaigns and lobbying skews the legislative process that sets pharmaceutical policy. Moreover, certain practices have corrupted medical research, the production of medical knowledge, the practice of medicine, drug safety, and the Food and Drug Administration’s oversight of pharmaceutical marketing.
As a result, practitioners may think they are using reliable information to engage in sound medical practice while actually relying on misleading information and therefore prescribe drugs that are unnecessary or harmful to patients, or more costly than equivalent medications. At the same time, patients and the public may believe that patient advocacy organizations effectively represent their interests while these organizations actually neglect their interests.
The entire journal is here.
The articles are organized into five topics: (1) systemic problems, (2) medical research, (3) medical knowledge and practice, (4) marketing, and (5) patient advocacy organizations.
Physicians Under the Influence: Social Psychology and Industry Marketing Strategies
By Sunita Sah and Adriane Fugh-Berman
April 30, 2013
Journal of Law, Medicine and Ethics, Volume 14, No. 3, August 2013,
Forthcoming Edmond J. Safra Working Papers, Forthcoming
Abstract
Pharmaceutical and medical device companies apply social psychology to influence physicians’ prescribing behavior and decision-making. Physicians fail to recognize their vulnerability to commercial influences; due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry’s routine marketing strategies, which rely on the illusion that the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias, and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame, rather than gratitude, will reduce conflicts of interest. If greater academic prestige accrues to distant, rather than close relationships with industry, a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated, but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession’s improper dependence on industry.
The entire paper is here.
April 30, 2013
Journal of Law, Medicine and Ethics, Volume 14, No. 3, August 2013,
Forthcoming Edmond J. Safra Working Papers, Forthcoming
Abstract
Pharmaceutical and medical device companies apply social psychology to influence physicians’ prescribing behavior and decision-making. Physicians fail to recognize their vulnerability to commercial influences; due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry’s routine marketing strategies, which rely on the illusion that the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias, and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame, rather than gratitude, will reduce conflicts of interest. If greater academic prestige accrues to distant, rather than close relationships with industry, a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated, but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession’s improper dependence on industry.
The entire paper is here.
Friday, September 6, 2013
Dangerous Doctors Allowed to Keep Practicing
By Peter Eisler and Barbara Hansen
USA Today
Originally published August 20, 2013
Here is an excerpt:
Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.
The problem isn't universal. Some state boards have responded to complaints and become more transparent and aggressive in policing bad doctors.
But state and federal records still paint a grim picture of a physician oversight system that often is slow to act, quick to excuse problems, and struggling to manage workloads in an era of tight state budgets.
USA TODAY reviewed records from multiple sources, including the public file of the National Practitioner Data Bank, a federal repository set up to help medical boards track physicians' license records, malpractice payments, and disciplinary actions imposed by hospitals, HMOs and other institutions that manage doctors. By law, reports must be filed with the Data Bank when any of the nation's 878,000 licensed doctors face "adverse actions" — and the reports are intended to be monitored closely by medical boards.
The entire narrative and video story is here.
USA Today
Originally published August 20, 2013
Here is an excerpt:
Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.
The problem isn't universal. Some state boards have responded to complaints and become more transparent and aggressive in policing bad doctors.
But state and federal records still paint a grim picture of a physician oversight system that often is slow to act, quick to excuse problems, and struggling to manage workloads in an era of tight state budgets.
USA TODAY reviewed records from multiple sources, including the public file of the National Practitioner Data Bank, a federal repository set up to help medical boards track physicians' license records, malpractice payments, and disciplinary actions imposed by hospitals, HMOs and other institutions that manage doctors. By law, reports must be filed with the Data Bank when any of the nation's 878,000 licensed doctors face "adverse actions" — and the reports are intended to be monitored closely by medical boards.
The entire narrative and video story is here.
Is prostitution harmful? - Views on Sexual Ethics
Ole Martin Moen
J Med Ethics doi:10.1136/medethics-2011-100367
Abstract
A common argument against prostitution states that selling sex is harmful because it involves selling something deeply personal and emotional. More and more of us, however, believe that sexual encounters need not be deeply personal and emotional in order to be acceptable—we believe in the acceptability of casual sex. In this paper I argue that if casual sex is acceptable, then we have few or no reasons to reject prostitution. I do so by first examining nine influential arguments to the contrary. These arguments purport to pin down the alleged additional harm brought about by prostitution (compared to just casual sex) by appealing to various aspects of its practice, such as its psychology, physiology, economics and social meaning. For each argument I explain why it is unconvincing. I then weight the costs against the benefits of prostitution, and argue that, in sum, prostitution is no more harmful than a long line of occupations that we commonly accept without hesitation.
The entire article is here.
J Med Ethics doi:10.1136/medethics-2011-100367
Abstract
A common argument against prostitution states that selling sex is harmful because it involves selling something deeply personal and emotional. More and more of us, however, believe that sexual encounters need not be deeply personal and emotional in order to be acceptable—we believe in the acceptability of casual sex. In this paper I argue that if casual sex is acceptable, then we have few or no reasons to reject prostitution. I do so by first examining nine influential arguments to the contrary. These arguments purport to pin down the alleged additional harm brought about by prostitution (compared to just casual sex) by appealing to various aspects of its practice, such as its psychology, physiology, economics and social meaning. For each argument I explain why it is unconvincing. I then weight the costs against the benefits of prostitution, and argue that, in sum, prostitution is no more harmful than a long line of occupations that we commonly accept without hesitation.
The entire article is here.
Thursday, September 5, 2013
Doctors Face New Scrutiny Over Gifts
By Peter Loftus
The Wall Street Journal
Originally published August 22, 2013
U.S. doctors are bracing for increased public scrutiny of
the payments and gifts they receive from pharmaceutical and medical-device
companies as a result of the new health law.
Starting this month, companies must record nearly every
transaction with doctors—from sales reps bearing pizza to compensation for
expert advice on research—to comply with the so-called Sunshine Act provision
of the U.S. health-care overhaul. The companies must report data on individual
doctors and how much they received to a federal health agency, which will post
it on a searchable, public website beginning September 2014.
Many doctors say the increased disclosures are making
them rethink their relationships with industry, citing concerns about privacy
and accuracy, and worry that the public will misinterpret the information. Some
fear patients will view the payments as tainting their medical decisions, and
will lump together compensation for research-related services with payments of
a more promotional nature.
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