How (Un)ethical Are You?

Mahzarin R. Banaji, Max H. Bazerman, & Dolly Chugh
Harvard Business Review
Originally published in 2003

Here is an excerpt:

Bias That Emerges from Unconscious Beliefs

Most fair-minded people strive to judge others according to their merits, but our research shows how often people instead judge according to unconscious stereotypes and attitudes, or “implicit prejudice.” What makes implicit prejudice so common and persistent is that it is rooted in the fundamental mechanics of thought. Early on, we learn to associate things that commonly go together and expect them to inevitably coexist: thunder and rain, for instance, or gray hair and old age. This skill—to perceive and learn from associations—often serves us well.

But, of course, our associations only reflect approximations of the truth; they are rarely applicable to every encounter. Rain doesn’t always accompany thunder, and the young can also go gray. Nonetheless, because we automatically make such associations to help us organize our world, we grow to trust them, and they can blind us to those instances in which the associations are not accurate—when they don’t align with our expectations.

Because implicit prejudice arises from the ordinary and unconscious tendency to make associations, it is distinct from conscious forms of prejudice, such as overt racism or sexism. This distinction explains why people who are free from conscious prejudice may still harbor biases and act accordingly.

The entire article is here.

Compliance with Results Reporting at ClinicalTrials.gov

By Monique L. Anderson and others
N Engl J Med 2015; 372:1031-1039
March 12, 2015
DOI: 10.1056/NEJMsa1409364

Here are two excerpts:

The human experimentation that is conducted in clinical trials creates ethical obligations to make research findings publicly available. However, there are numerous historical examples of potentially harmful data being withheld from public scrutiny and selective publication of trial results. In 2000, Congress authorized the creation of the ClinicalTrials.gov registry to provide information about and access to clinical trials for persons with serious medical conditions. In 2007, Section 801 of the Food and Drug Administration Amendments Act (FDAAA) expanded this mandate by requiring sponsors of applicable clinical trials to register and report basic summary results at ClinicalTrials.gov. Such trials generally include all non–phase 1 interventional trials of drugs, medical devices, or biologics that were initiated after September 27, 2007, or before that date but that were still ongoing as of December 26, 2007, have at least one U.S. research site, or are conducted under an investigational-new-drug application or an investigational-device exemption. The FDAAA also mandates that trial results be reported by the sponsor within 1 year after the completion of data collection for the prespecified primary outcome (primary completion date) or within 1 year after the date of early termination, unless legally acceptable reasons for the delay are evident.

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In conclusion, despite ethical mandates, statutory obligations, and considerable societal pressure, most trials that were funded by the NIH or other government or academic institutions and were subject to FDAAA provisions have yet to report results at ClinicalTrials.gov, whereas the medical-products industry has been more responsive to the legal mandate of the FDAAA. However, industry, the NIH, and other government and academic institutions all performed poorly with respect to ethical obligations for transparency.

The entire article is here.

Teaching doctors how to engage more and lecture less

By Sandra G. Boodman
The Washington Post
Originally posted March 9, 2015

Here is an excerpt:

“Doctors are explainaholics,” Tulsky said. “Our answer to distress is more information, that if a patient just understood it better, they would come around.” In reality, bombarding a patient with information does little to alleviate the underlying worry.

The “Empathetics” program teaches doctors “how to show up, not what to say,” said Riess. “We do a lot of training in emotional recognition and self-monitoring.” That includes learning to identify seven universal facial expressions — using research pioneered by psychologist Paul Ekman — and to take stock of one’s own emotional responses to patients or situations.

The entire article is here.

Ethical Implications of Patients and Families Secretly Recording Conversations With Physicians

By Michelle Rodriguez, Jason Morrow, and Ali Seifi
JAMA.
Published online March 12, 2015. doi:10.1001/jama.2015.2424

Here are two excerpts:

Recording conversations could be beneficial for patients. Patients do not always understand or recall all the information provided during visits to physicians.  Recordings could potentially improve accuracy, adherence, and personal engagement by providing opportunities to review conversations at other times, from the comfort of home, and in conjunction with other family members or caregivers.

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Not all possible uses of these recorded conversations are beneficial to patients and physicians. Patients or family members who disagree with the advice of their physicians or who are upset with their physicians for whatever reason can easily take comments from these recordings out of context and, with a few keystrokes, disseminate them via social media. Patients can conceivably record conversations with the specific intent of establishing the grounds for a lawsuit or gathering material with which to manipulate a physician.

The entire article is here.

Ethical Breakdowns

Max H. Bazerman and Ann E. Tenbrunsel

Harvard Business Review

Originally published in April 2011

Here is an excerpt:

Motivated Blindness

It’s well documented that people see what they want to see and easily miss contradictory information when it’s in their interest to remain ignorant—a psychological phenomenon known as motivated blindness. This bias applies dramatically with respect to unethical behavior. At Ford the senior-most executives involved in the decision to rush the flawed Pinto into production not only seemed unable to clearly see the ethical dimensions of their own decision but failed to recognize the unethical behavior of the subordinates who implemented it.

Let’s return to the 2008 financial collapse, in which motivated blindness contributed to some bad decision making. The “independent” credit rating agencies that famously gave AAA ratings to collateralized mortgage securities of demonstrably low quality helped build a house of cards that ultimately came crashing down, driving a wave of foreclosures that pushed thousands of people out of their homes. Why did the agencies vouch for those risky securities?

Part of the answer lies in powerful conflicts of interest that helped blind them to their own unethical behavior and that of the companies they rated. The agencies’ purpose is to provide stakeholders with an objective determination of the creditworthiness of financial institutions and the debt instruments they sell.

The entire article is here.

Unraveling the Church Ban on Gay Sex

By Gary Gutting
The New York Times
Originally published March 12, 2015

Here is an excerpt:

The primary arguments derive from what is known as the “natural-law tradition” of ethical thought, which begins with Plato and Aristotle, continues through Thomas Aquinas and other medieval and modern philosophers, and still flourishes today in the work of thinkers like John Finnis and Robert George. This tradition sees morality as a matter of the moral laws that follow from what fundamentally makes us human: our human nature. This is what the archbishop was referring to when he said that homosexual acts are contrary to natural law. This has long been a major basis for the church’s claim that homosexual acts are immoral — indeed “gravely sinful.”

The problem is that, rightly developed, natural-law thinking seems to support rather than reject the morality of homosexual behavior. 

The entire article is here.

What Can Be Done about Pseudoskepticism?

By Michael Shermer
Scientific American
Originally published February 17, 2015

Here is an excerpt:

Climate change is the latest arena for pseudoskepticism, and the front group du jour is ClimateDepot.com, financed in part by Chevron and Exxon and headed by a colorful character named Marc Morano, who told Kenner: “I'm not a scientist, but I do play one on TV occasionally … hell, more than occasionally.” Morano's motto to challenge climate science, about which he admits he has no scientific training, is “keep it short, keep it simple, keep it funny.” That includes ridiculing climate scientists such as James E. Hansen of Columbia University. “You can't be afraid of the absolute hand-to-hand combat metaphorically. And you've got to name names, and you've got to go after individuals,” he says, adding with a wry smile, “I think that's what I enjoy the most.”

The entire article is here.

Guidelines for Best Practices in Electronic Communications

Ontario Psychological Association
February 2015

Preamble

Preamble Technology has been changing communication between psychological service providers and patients, referral sources, other healthcare providers and third-party payers. Members may be aware of websites, applications, and email communication tools that can be used to improve the delivery of patient care. Many of us use email extensively because it is fast, reliable, and convenient. These same characteristics, however, bring legal and liability risks, including a higher potential for privacy breaches.

As regulated health professionals, we have an obligation to maintain the confidentiality of our patients' personal health information (PHI) and to comply with privacy regulations (see Appendix A). Members need to consider how to communicate with and about patients while still protecting patient privacy. While email is fast and convenient, it also is often the least secure and the least private way to communicate.

 We are aware that many larger healthcare and academic settings now have policies stating that email should not be used to transmit any PHI. We are also aware that general guidelines for use of email suggest that it is not a secure form of communication for any personal information. Most guidelines for general email use suggest that information that is sensitive, confidential, potentially embarrassing, proprietary, personal, or classified should never be sent through email.

While members practicing within healthcare and academic settings may be familiar with their institution’s policies, those in community-based practice may not be as familiar with regulations and expectations regarding electronic communication. To clarify the responsibilities of members, the Ontario Psychological Association’s Communication and Member Services Committee is providing the following Guidelines for Best Practices in Electronic Communications.

The entire helpful guide is here.

Homeopathy not effective for treating any condition, Australian report finds

Report by top medical research body says ‘people who choose homeopathy may put their health at risk if they reject or delay treatments’

By Melissa Davey
The Guardian
Originally published March 11, 2015

Homeopathy is not effective for treating any health condition, Australia’s top body for medical research has concluded, after undertaking an extensive review of existing studies.

Homeopaths believe that illness-causing substances can, in minute doses, treat people who are unwell.

By diluting these substances in water or alcohol, homeopaths claim the resulting mixture retains a “memory” of the original substance that triggers a healing response in the body.

The entire article is here.