Social Mission in Health Professions Education: Beyond Flexner

Fitzhugh Mullan
JAMA: Viewpoint
Originally published June 26, 2017

Here is an excerpt:

Today, with a broader recognition of the importance of social determinants of health and a better understanding of the substantial health disparities within the United States, new ideas are circulating and important experiments in curricular redesign are taking place at many schools. Accountable care organizations, primary care medical homes, interprofessional education, cost consciousness, and teaching health centers are all present to some degree in the curricula of health professions schools and teaching hospitals, and all have dimensions of social mission. These developments are encouraging, but the creative focus on social mission that they represent needs to be widely embraced, becoming a core value of all health professions educational institutions, including schools, teaching hospitals, and postgraduate training programs.

Toward that end, the unqualified commitment of these institutions to teaching and modeling social mission is needed, as are the voices of academic professional organizations, accrediting bodies, and student groups who have important roles in defining the values of young professionals. The task is interprofessional and should involve other disciplines including nursing, dentistry, public health, physician assistants, and, perhaps, law and social work. The commitments needed are not the domain of any one profession, and collaborative initiatives at the educational level will reinforce social mission norms in practice. The precision with which health disparities and the morbidity and mortality that they represent can be documented calls on all health professions schools, academic health centers, and teaching hospital to place their commitment to social mission alongside their dedication to education, research, and service in pursuit of a healthier and fairer society.

The article is here.

Professors lead call for ethical framework for new 'mind control' technologies

Medical Xpress
Originally published July 6, 2017

Here is an excerpt:

As advances in molecular biology and chemical engineering are increasing the precision of pharmaceuticals, even more spatially-targeted technologies are emerging. New noninvasive treatments send electrical currents or magnetic waves through the scalp, altering the ability of neurons in a targeted region to fire. Surgical interventions are even more precise; they include implanted electrodes that are designed to quell seizures before they spread, or stimulate the recall of memories after a traumatic brain injury.

Research into the brain's "wiring"—how neurons are physically connected in networks that span disparate parts of the brain—and how this wiring relates to changing mental states has enabled principles from control theory to be applied to neuroscience. For example, a recent study by Bassett and colleagues shows how changes in brain wiring from childhood through adolescence leads to greater executive function, or the ability to consciously control one's thoughts and attention.

While insights from network science and control theory may support new treatments for conditions like obsessive compulsive disorder and traumatic brain injury, the researchers argue that clinicians and bioethicists must be involved in the earliest stages of their development. As the positive effects of treatments become more profound, so do their potential side effects.

"New methods of controlling mental states will provide greater precision in treatments," Sinnott-Armstrong said, "and we thus need to think hard about the ensuing ethical issues regarding autonomy, privacy, equality and enhancement."

The article is here.

The Only Way Is Ethics: Why Good People do Bad Thing and How To Stop Us

www.ethicalsystems.org
MindGym

Forward

In social psychology we have this thing called the ‘fundamental attribution error.’ It refers
to the fact that when people see somebody do something unusual, their first reaction
is to assume that the act expressed the person’s internal values or personality (“he’s such
a crook!”), and underestimate the power of external factors and pressures. So, when we
hear about a company brought down by an ethics scandal, we immediately search for
the culprits, the bad actors, the bad apples. We can almost always find them, fire them,
maybe indict them, and move on… to the next scandal.

Sometimes a scandal is caused by one psychopath or sleazebag in the C-suite. But
usually not. If you really want to understand the causes of cheating, risky and unethical
behavior within complex organizations, you have to get past this attributional error
and examine the barrel, not just the apples in the barrel. You have to learn some social
psychology, which is like putting on a pair of magic glasses that let you see social
forces and cognitive biases in action.

Once you see how profoundly we are all shaped by local organizational culture, and how
clueless we often are about the real causes behind our actions, you can begin to work
with human psychology, adapt your processes to it, and obtain far better results.
Mind Gym shines a spotlight on this challenge in this whitepaper. A great deal of their
evidence shows that having ethics pays, yet most organizations focus on compliance,
rather than on ethics. Mind Gym offers you a set of tools and a framework to begin
diagnosing your own organization. And they offer concrete advice for improvement.
It is crucial that your organization is aligned on ethics at all levels – you may not see
results from just changing one or two processes. If you want to run a great organization
that employees are proud to work for, and that customers buy from with high trust, then
you should consider making an all-out commitment to ethics. You should consider
doing ethical systems design.

The White Paper can be downloaded here.

Emotion shapes the diffusion of moralized content in social networks

William J. Brady, Julian A. Wills, John T. Jost, Joshua A. Tucker, and Jay J. Van Bavel
PNAS 2017 ; published ahead of print June 26, 2017

Abstract

Political debate concerning moralized issues is increasingly common in online social networks. However, moral psychology has yet to incorporate the study of social networks to investigate processes by which some moral ideas spread more rapidly or broadly than others. Here, we show that the expression of moral emotion is key for the spread of moral and political ideas in online social networks, a process we call “moral contagion.” Using a large sample of social media communications about three polarizing moral/political issues (n = 563,312), we observed that the presence of moral-emotional words in messages increased their diffusion by a factor of 20% for each additional word. Furthermore, we found that moral contagion was bounded by group membership; moral-emotional language increased diffusion more strongly within liberal and conservative networks, and less between them. Our results highlight the importance of emotion in the social transmission of moral ideas and also demonstrate the utility of social network methods for studying morality. These findings offer insights into how people are exposed to moral and political ideas through social networks, thus expanding models of social influence and group polarization as people become increasingly immersed in social media networks.

The research is here.

Suicide and self-harm in prisons hit worst ever levels

Rajeev Syal
The Guardian
Originally posted June 28, 2017

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

The article is here.

Moral Judgments and Social Stereotypes: Do the Age and Gender of the Perpetrator and the Victim Matter?

Qiao Chu, Daniel Grühn
Social Psychological and Personality Science
First Published June 19, 2017

Abstract
We investigated how moral judgments were influenced by (a) the age and gender of the moral perpetrator and victim, (b) the moral judge’s benevolent ageism and benevolent sexism, and (c) the moral judge’s gender. By systematically manipulating the age and gender of the perpetrators and victims in moral scenarios, participants in two studies made judgments about the moral transgressions. We found that (a) people made more negative judgments when the victims were old or female rather than young or male, (b) benevolent ageism influenced people’s judgments about young versus old perpetrators, and (c) people had differential moral expectations of perpetrators who belonged to their same-gender group versus opposite-gender group. The findings suggest that age and gender stereotypes are so salient to bias people’s moral judgments even when the transgression is undoubtedly intentional and hostile.

The article is here.

Men Can Be So Hormonal

Therese Huston
The New York Times
Originally posted June 24, 2017

Here is an excerpt:

People don’t like to believe that they’re average. But compared with women, men tend to think they’re much better than average.

If you feel your judgment is right, are you interested in how others see the problem? Probably not. Nicholas D. Wright, a neuroscientist at the University of Birmingham in Britain, studies how fluctuations in testosterone shape one’s willingness to collaborate.  Most testosterone researchers study men, for obvious reasons, but Dr. Wright and his team focus on women. They asked women to perform a challenging perceptual task: detecting where a fuzzy pattern had appeared on a busy computer screen. When women took oral testosterone, they were more likely to ignore the input of others, compared with women in the placebo condition. Amped up on testosterone, they relied more heavily on their own judgment, even when they were wrong.

The findings of the latest study, which have been presented at conferences and will be published in Psychological Science in January, offer more reasons to worry about testosterone supplements.

The article is here.

When Are Doctors Too Old to Practice?

By Lucette Lagnado
The Wall Street Journal
Originally posted June 24, 2017

Here is an excerpt:

Testing older physicians for mental and physical ability is growing more common. Nearly a fourth of physicians in America are 65 or older, and 40% of these are actively involved in patient care, according to the American Medical Association. Experts at the AMA have suggested that they be screened lest they pose a risk to patients. An AMA working group is considering guidelines.

Concern over older physicians' mental states--and whether it is safe for them to care for patients--has prompted a number of institutions, from Stanford Health Care in Palo Alto, Calif., to Driscoll Children's Hospital in Corpus Christi, Texas, to the University of Virginia Health System, to adopt age-related physician policies in recent years. The goal is to spot problems, in particular signs of cognitive decline or dementia.

Now, as more institutions like Cooper embrace the measures, they are roiling some older doctors and raising questions of fairness, scientific validity--and ageism.

"It is not for the faint of heart, this policy," said Ann Weinacker, 66, the former chief of staff at the hospital and professor of medicine at Stanford University who has overseen the controversial efforts to implement age-related screening at Stanford hospital.

A group of doctors has been battling Stanford's age-based physician policies for the past five years, contending they are demeaning and discriminatory. The older doctors got the medical staff to scrap a mental-competency exam aimed at testing for cognitive impairment. Most, like Frank Stockdale, an 81-year-old breast-cancer specialist, refused to take it.

The article is here.

Big Pharma gives your doctor gifts. Then your doctor gives you Big Pharma’s drugs

Nicole Van Groningen
The Washington Post
Originally posted June 13, 2017

Here is an excerpt:

The losers in this pharmaceutical industry-physician interaction are, of course, patients. The high costs of branded drugs are revenue to drug companies, but out-of-pocket expenses to health-care consumers. Almost a quarter of Americans who take prescription drugs report that they have difficulty affording their medications, and the high costs of these drugs is a leading reason that patients can’t adhere to them. Most branded drugs offer minimal — if any — benefit over generic formulations. And if doctors prescribe brand-name drugs that are prohibitively more expensive than generic options, patients might forgo the medications altogether — causing greater harm.

On a national scale, the financial burden imposed by branded drugs is enormous. Current estimates place our prescription drug spending at more than $400 billion annually, and branded drugs are almost entirely to blame: Though they constitute only 10 percent of prescriptions, they account for 72 percent of total drug spending. Even modest reductions in our use of branded prescription drugs — on par with the roughly 8 percent relative reduction seen in the JAMA study — could translate to billions of dollars in national health-care savings.

The article is here.