Implicit Bias in Patient Care: An Endemic Blight on Quality Care

JoAnn Grif Alspach
Critical Care Nurse
August 2018 vol. 38 no. 4 12-16

Here is an excerpt:

How Implicit Bias Is Manifested

A systematic review by Hall and colleagues revealed that implicit bias is manifested in 4 key areas: patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. How a physician communicates, including verbal cues, body language, and nonverbal behavior (physical proximity, frequency of eye contact) may manifest subconscious bias.7,10 Several investigators found evidence that providers interact more effectively with white than nonwhite patients. Bias may affect the nature and extent of diagnostic assessments and the range and scope of therapies considered. Nonwhite patients receive fewer cardiovascular interventions and kidney transplants. One meta-analysis found that 20 of 25 assumption method studies demonstrated bias either in the diagnosis, treatment recommendations, number of questions asked, or tests ordered. Women are 3 times less likely than men to receive knee arthroplasty despite comparable indications. Bias can detrimentally affect whether patients seek or return for care, follow treatment protocols, and, perhaps cumulatively, can influence outcomes of care. Numerous research studies offer evidence that implicit bias is associated with higher complication rates, greater morbidity, and higher patient mortality.

The info is here.

Designing a Roadmap to Ethical AI in Government

Joshua Entsminger, Mark Esposito, Terence Tse and Danny Goh
www.thersa.org
Originally posted July 23, 2018

Here is an excerpt:

When a decision was made using AI, we may not know whether or not the data was faulty; regardless, there will come a time when someone appeals a decision made by, or influenced by, AI-driven insights. People have the right to be informed that a significant decision concerning their lives was carried out with the help of an AI. Governments will need a better record of what companies and institutions use AI for making significant decisions to enforce this policy.

When specifically assessing a decision-making process of concern, the first step should be to determine whether or not the data set represents what the organisation wanted the AI to understand and make decisions about.

However, data sets, particularly easily available data sets, cover a limited range of situations, and inevitably, most AI will be confronted with situations they have not encountered before – the ethical issue is the framework by which decisions occur, and good data cannot secure that kind of ethical behavior by itself.

The blog post is here.

The Genetics (and Ethics) of Making Humans Fit for Mars

Jason Pontin
www.wired.com
Originally published August 7, 2018

Here is an excerpt:

In the first stage of his plan, Mason is combining human cells with a gene called Dsup, unique to the indestructible tardigrade, that suppresses DNA breaks from radiation. Tardigrades can survive the vacuum of space; perhaps their genes might make us more fit for space, too. His lab has also created an artificial construct of the gene p53, involved in preventing cancer, which it hopes later to insert into a human cell. Elephants have many copies of p53 and seldom die from cancer; adding copies of p53 to human genomes might protect us from space radiation. Mason’s less speculative research includes editing Deionococcus radiodurans, sometimes called “Conan the bacterium,” a polyextremophile that can survive cold, dehydration, acid, and very high levels of radiation, the last by rewriting its damaged chromosomes. Mason wants the microbe to live as flora on our skin or in our guts, or on the surfaces of spaceships, protecting us from the deadly rays of space. “The microbiome is an extraordinarily plastic thing,” he says.

Some researchers have proposed more science-fictional projects. Harris Wang of Columbia wants to coax human kidney cells to synthesize the nine amino acids our bodies cannot make. A human cell able to synthesize all the organic compounds needed for health would require around 250 new genes, but if our tissues were made of such cells, astronauts could thrive by drinking just sugar water, a liberating adaptation: Missions wouldn’t have to lug bulky food or send it on ahead. Other scientists have suggested photosynthetic spacefarers, or editing the personalities of the space corps, so that they fearlessly longed for the high frontier because it was their true terminus.

The info is here.

Has Genetic Privacy Been Strained By Trump's Recent ACA Moves?

Michelle Andrews
www.npr.org
Originally posted July 11, 2018

Here is an excerpt:

However, if you develop symptoms of a disease or are diagnosed with a medical condition, GINA no longer protects you. That's where the Affordable Care Act steps in. It prohibits health plans from turning people down or charging them more because they have a pre-existing condition.

"GINA did something good, and the ACA was the next important step," said Sonia Mateu Suter, a law professor at George Washington University who specializes in genetics and the law.

The Trump administration put those additional ACA protections in doubt last month when it said it won't defend that part of the law, which is being challenged in a lawsuit brought by the attorneys general of 20 states.

The administration said that since the penalty for not having health insurance has been eliminated starting in 2019, the provisions that guarantee coverage to people with pre-existing conditions and prohibit insurers from charging them higher premiums should be struck down as well.

The protections are a priority with many voters. In a June poll by the Kaiser Family Foundation, two-thirds of voters said that continuing protections for people with pre-existing conditions will be either the single most important factor or very important in determining their vote in this fall's elections.

The information is here.

Double time limit for embryo research, say ethics experts

Science News
August 7, 2018

Currently, research on embryos is limited in many countries to a maximum period of 14 days after their fertilisation in the lab.

But ethicists Dr John Appleby of Lancaster University with Professor Dr Annelien Bredenoord of University Medical Center Utrecht believe the current limit is "no longer adequate for current scientific developments."

Dr Appleby and Professor Dr Bredenoord said: "The 14 day rule has been a very successful example of international science regulation, but it should not become a dogma in itself and it should be revisited when no longer fit to purpose."

Until recently, scientists have not been able to culture and sustain embryos in vitro as long as (or beyond) 14 days but this has now changed.

"There are both scientific and ethical reasons to extent the 14 day rule to for example 28 days. Extending the window for embryo research to 28 days would allow scientists to reveal a new in-depth chapter of knowledge about the developmental processes that take place in embryos."

The info is here.

Ethical Concerns Raised by Illicit Human Experiments

David Tereshchuk
Religion and Ethics - PBS.org
Originally posted July 16, 2018

Institutional regulation in science – including medical science – is undergoing one of its periodic assaults by proponents of greater freedom in research. These proponents argue (most of them in entirely good faith, I should stress) that experimentation is often needlessly hampered by too much official control. Formal constraints, they say, can cramp the kind of spontaneous improvisation that leads to unexpected, sometime spectacular, breakthroughs.

As reported by Marisa Taylor of Kaiser Health News, it has been revealed that the federal Food and Drug Administration (who won’t officially confirm this) is pursuing criminal inquiries into an egregious case of medical experimentation – conducted illicitly in off-shore locations and in hotel rooms on American soil.

The procedures under investigation were self-styled drug ‘trials’ – apparently a last-ditch effort by a university professor of microbiology, William Halford who – knowing he was dying from an incurable cancer – evidently threw both professional caution and ethics to the winds. He embarked hell-bent on a test-program for a herpes vaccine he’d invented, but for which he hadn’t gained FDA approval – a program that involved injecting it into human subjects.

The information is here.

Ethics and the pursuit of artificial intelligence

Daniel Wagner
South China Morning Post
Originally posted August 6, 2018

So many businesses and governments are scurrying to get into the artificial intelligence (AI) race that many appear to be losing sight of some important things that should matter along the way – such as legality, good governance, and ethics.

In the AI arena the stakes are extremely high and it is quickly becoming a free-for-all from data acquisition to the stealing of corporate and state secrets. The “rules of the road” are either being addressed along the way or not at all, since the legal regime governing who can do what to whom, and how, is either wholly inadequate or simply does not exist. As is the case in the cyber world, the law is well behind the curve.

Ethical questions abound with AI systems, raising questions about how machines recognise and process values and ethical paradigms. AI is certainly not unique among emerging technologies in creating ethical quandaries, but ethical questions in AI research and development present unique challenges in that they ask us to consider whether, when, and how machines should make decisions about human lives – and whose values should guide those decisions.

In a world filled with unintended consequences, will our collectively shared values fall by the wayside in an effort to reach AI supremacy? Will the notion of human accountability eventually disappear in an AI-dominated world? Could the commercial AI landscape evolve into a winner takes all arena in which only one firm or machine is left standing?

The information is here.

Massachusetts allows school to continue with electric shocks

Jeffrey Delfin
theguardian.com
Originally posted July 12, 2108

Here is an excerpt:

The device is not used in what we might call “electroshock therapy” – where small shocks are passed through the brain under anesthesia. Rather, the GED is used as a variation of “aversive conditioning”, in which negative stimulation is applied to a patient when he or she performs an unwanted action. The patient is awake, and feeling pain is the point of the shock.

The GED, when activated, outputs an electric shock that is distributed to the patient’s skin for up to two seconds. Students wear a backpack containing the shocking device, with electrodes constantly affixed to their skin. Staff are able to shock students at any point during the day. Previous attendees at JRC have spoken of up to five electrodes being attached to their bodies. One, Jen Msumba, who blogs about her time at the facility, said electrodes were applied under their fingers or the bottom of their feet to increase the pain.

“We’ve all experienced aversive conditioning. We touch the stove while it’s still hot, it hurts, then we become very cautious about touching it,” says Dr Jean Mercer, the leader of the group Advocates for Children in Therapy, a not-for-profit organization dedicated to ending harmful practices for treating children’s mental health.

The information is here.

Druggists Shouldn't Act as Morality Police

The Editors
Scientific American
Originally published July 18, 2018

Here is an excerpt:

In states with conscience carve-outs for pharmacists, pharmacies honoring those policies should be required to preemptively notify state authorities and medical providers that they might refuse service.

That way, women and their doctors could make alternative arrangements to fill prescriptions at pharmacies that will give them the medications they need —avoiding situations like the recent one in Arizona. (This follows a model worked out in 2014, when the Supreme Court told the Obama administration that employers with moral objections did not have to offer an insurance plan with birth control coverage. But such employers did have to notify the Department of Health and Human Services so the government and insurers could provide birth control coverage via a private insurance plan or a government-sponsored one.)

And in situations where individual pharmacists may refuse service—even if their pharmacies generally fill family-planning prescriptions—there should be a legal requirement to automatically refer that prescription to another pharmacy within a certain reasonable distance or to have a backup pharmacist on call to do the work so that patients can get medications quickly and efficiently.

The information is here.