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

Monday, April 24, 2017

How Flawed Science Is Undermining Good Medicine

Morning Edition
NPR.org
Originally posted April 6, 2017

Here is an excerpt:

A surprising medical finding caught the eye of NPR's veteran science correspondent Richard Harris in 2014. A scientist from the drug company Amgen had reviewed the results of 53 studies that were originally thought to be highly promising — findings likely to lead to important new drugs. But when the Amgen scientist tried to replicate those promising results, in most cases he couldn't.

"He tried to reproduce them all," Harris tells Morning Edition host David Greene. "And of those 53, he found he could only reproduce six."

That was "a real eye-opener," says Harris, whose new book Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions explores the ways even some talented scientists go wrong — pushed by tight funding, competition and other constraints to move too quickly and sloppily to produce useful results.

"A lot of what everybody has reported about medical research in the last few years is actually wrong," Harris says. "It seemed right at the time but has not stood up to the test of time."

The impact of weak biomedical research can be especially devastating, Harris learned, as he talked to doctors and patients. And some prominent scientists he interviewed told him they agree that it's time to recognize the dysfunction in the system and fix it.

The article is here.

Scientists Hack a Human Cell and Reprogram it Like a Computer

Sophia Chen
Wired Magazine
Originally published March 27, 2017

CELLS ARE BASICALLY tiny computers: They send and receive inputs and output accordingly. If you chug a Frappuccino, your blood sugar spikes, and your pancreatic cells get the message. Output: more insulin.

But cellular computing is more than just a convenient metaphor. In the last couple of decades, biologists have been working to hack the cells’ algorithm in an effort to control their processes. They’ve upended nature’s role as life’s software engineer, incrementally editing a cell’s algorithm—its DNA—over generations. In a paper published today in Nature Biotechnology, researchers programmed human cells to obey 109 different sets of logical instructions. With further development, this could lead to cells capable of responding to specific directions or environmental cues in order to fight disease or manufacture important chemicals.

Their cells execute these instructions by using proteins called DNA recombinases, which cut, reshuffle, or fuse segments of DNA. These proteins recognize and target specific positions on a DNA strand—and the researchers figured out how to trigger their activity. Depending on whether the recombinase gets triggered, the cell may or may not produce the protein encoded in the DNA segment.

The article is here.

Sunday, April 23, 2017

Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study

Blair E. Wisco Ph.D., Brian P. Marx Ph.D., Casey L. May B.S., Brenda Martini M.A., and others
Depression and Anxiety

Abstract

Background

Combat exposure is associated with increased risk of mental disorders and suicidality. Moral injury, or persistent effects of perpetrating or witnessing acts that violate one's moral code, may contribute to mental health problems following military service. The pervasiveness of potentially morally injurious events (PMIEs) among U.S. combat veterans, and what factors are associated with PMIEs in this population remains unknown.
Methods

Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary and nationally representative survey of a population-based sample of U.S. veterans, including 564 combat veterans, collected September–October 2013. Types of PMIEs (transgressions by self, transgressions by others, and betrayal) were assessed using the Moral Injury Events Scale. Psychiatric and functional outcomes were assessed using established measures.
Results

A total of 10.8% of combat veterans acknowledged transgressions by self, 25.5% endorsed transgressions by others, and 25.5% endorsed betrayal. PMIEs were moderately positively associated with combat severity (β = .23, P < .001) and negatively associated with white race, college education, and higher income (βs = .11–.16, Ps < .05). Transgressions by self were associated with current mental disorders (OR = 1.65, P < .001) and suicidal ideation (OR = 1.67, P < .001); betrayal was associated with postdeployment suicide attempts (OR = 1.99, P < .05), even after conservative adjustment for covariates, including combat severity.
Conclusions

A significant minority of U.S combat veterans report PMIEs related to their military service. PMIEs are associated with risk for mental disorders and suicidality, even after adjustment for sociodemographic variables, trauma and combat exposure histories, and past psychiatric disorders.

The article is here.

Saturday, April 22, 2017

As Trump Inquiries Flood Ethics Office, Director Looks To House For Action

By Marilyn Geewax and Peter Overby
npr.org
Originally published April 17, 2017

Office of Government Ethics Director Walter Shaub Jr. is calling on the chairman of House Oversight Committee to become more engaged in overseeing ethics questions in the Trump administration.

In an interview with NPR on Monday, Shaub said public inquiries and complaints involving Trump administration conflicts of interest and ethics have been inundating his tiny agency, which has only advisory power.

"We've even had a couple days where the volume was so huge it filled up the voicemail box, and we couldn't clear the calls as fast as they were coming in," Shaub said. His office is scrambling to keep pace with the workload.

But while citizens, journalists and Democratic lawmakers are pushing for investigations, Shaub suggested a similar level of energy is not coming from the House Oversight Committee, which has the power to investigate ethics questions, particularly those being raised now about reported secret ethics waivers for former lobbyists serving in the Trump administration.

The article is here.

Friday, April 21, 2017

Facebook plans ethics board to monitor its brain-computer interface work

Josh Constine
Tech Crunch
Originally posted April 19, 2017

Facebook will assemble an independent Ethical, Legal and Social Implications (ELSI) panel to oversee its development of a direct brain-to-computer typing interface it previewed today at its F8 conference. Facebook’s R&D department Building 8’s head Regina Dugan tells TechCrunch, “It’s early days . . . we’re in the process of forming it right now.”

Meanwhile, much of the work on the brain interface is being conducted by Facebook’s university research partners like UC Berkeley and Johns Hopkins. Facebook’s technical lead on the project, Mark Chevillet, says, “They’re all held to the same standards as the NIH or other government bodies funding their work, so they already are working with institutional review boards at these universities that are ensuring that those standards are met.” Institutional review boards ensure test subjects aren’t being abused and research is being done as safely as possible.

The article is here.

Individuals at High Risk for Suicide Are Categorically Distinct From Those at Low Risk.

Tracy K. Witte, Jill M. Holm-Denoma, Kelly L. Zuromski, Jami M. Gauthier, & John Ruscio
Psychological Assessment, Vol 29(4), Apr 2017, 382-393

Abstract

Although suicide risk is often thought of as existing on a graded continuum, its latent structure (i.e., whether it is categorical or dimensional) has not been empirically determined. Knowledge about the latent structure of suicide risk holds implications for suicide risk assessments, targeted suicide interventions, and suicide research. Our objectives were to determine whether suicide risk can best be understood as a categorical (i.e., taxonic) or dimensional entity, and to validate the nature of any obtained taxon. We conducted taxometric analyses of cross-sectional, baseline data from 16 independent studies funded by the Military Suicide Research Consortium. Participants (N = 1,773) primarily consisted of military personnel, and most had a history of suicidal behavior. The Comparison Curve Fit Index values for MAMBAC (.85), MAXEIG (.77), and L-Mode (.62) all strongly supported categorical (i.e., taxonic) structure for suicide risk. Follow-up analyses comparing the taxon and complement groups revealed substantially larger effect sizes for the variables most conceptually similar to suicide risk compared with variables indicating general distress. Pending replication and establishment of the predictive validity of the taxon, our results suggest the need for a fundamental shift in suicide risk assessment, treatment, and research. Specifically, suicide risk assessments could be shortened without sacrificing validity, the most potent suicide interventions could be allocated to individuals in the high-risk group, and research should generally be conducted on individuals in the high-risk group.

The article is here.

Thursday, April 20, 2017

Victims, vectors and villains: are those who opt out of vaccination morally responsible for the deaths of others?

Euzebiusz Jamrozik, Toby Handfield, Michael J Selgelid
Journal of Medical Ethics 2016;42:762-768.

Abstract

Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate.

The article is here.

White House may have violated its own ethics rules with Trump's executive-branch hires

Sonam Sheth
Business Insider
Originally published April 16, 2017

The Trump administration may be entangling itself in another ethical landmine.

In this case, the White House could have violated its own ethics rules with at least two hires, a New York Times and ProPublica investigation found.

One potential conflict involves Michael Catanzaro, who is the White House's top energy adviser. Until last year, The Times and ProPublica found, Catanzaro was working as a lobbyist for the fossil-fuel industry and had clients like Devon Energy of Oklahoma and Talen Energy of Pennsylvania.

Those two companies were stalwart opponents of President Barack Obama's environmental regulations, like the Clean Power Plan, which sought to promote the use of alternative energy sources. Trump signed an executive order undoing the plan in March. As the White House's top energy adviser, Catanzaro will handle many of those same issues.

The article is here.

Wednesday, April 19, 2017

Should Mental Disorders Be a Basis for Physician-Assisted Death?

Paul S. Appelbaum
Psychiatric Services
Volume 68, Issue 4, April 01, 2017, pp. 315-317

Abstract

Laws permitting physician-assisted death in the United States currently are limited to terminal conditions. Canada is considering whether to extend the practice to encompass intractable suffering caused by mental disorders, and the question inevitably will arise in the United States. Among the problems seen in countries that have legalized assisted death for mental disorders are difficulties in assessing the disorder’s intractability and the patient’s decisional competence, and the disproportionate involvement of patients with social isolation and personality disorders. Legitimate concern exists that assisted death could serve as a substitute for creating adequate systems of mental health treatment and social support.

The article is here.