A Conversation Between Dan Dennett and Gregg Caruso
aeon.co
Originally published October 4, 2018
Here is an excerpt:
There are additional concerns as well. As I argue in my Public Health and Safety (2017), the social determinants of criminal behaviour are broadly similar to the social determinants of health. In that work, and elsewhere, I advocate adopting a broad public-health approach for identifying and taking action on these shared social determinants. I focus on how social inequities and systemic injustices affect health outcomes and criminal behaviour, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental-health issues), how homelessness and education affects health and safety outcomes, how environmental health is important to both public health and safety, how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, and how a public-health approach can be successfully applied within the criminal justice system. I argue that, just as it is important to identify and take action on the social determinants of health if we want to improve health outcomes, it is equally important to identify and address the social determinants of criminal behaviour. My fear is that the system of desert you want to preserve leads us to myopically focus on individual responsibility and ultimately prevents us from addressing the systemic causes of criminal behaviour.
Consider, for example, the crazed reaction to [the then US president Barack] Obama’s claim that, ‘if you’ve got a [successful] business, you didn’t build that’ alone. The Republicans were so incensed by this claim that they dedicated the second day of the 2012 Republican National Convention to the theme ‘We Built it!’ Obama’s point, though, was simple, innocuous, and factually correct. To quote him directly: ‘If you’ve been successful, you didn’t get there on your own.’ So, what’s so threatening about this? The answer, I believe, lies in the notion of just deserts. The system of desert keeps alive the belief that if you end up in poverty or prison, this is ‘just’ because you deserve it. Likewise, if you end up succeeding in life, you and you alone are responsible for that success. This way of thinking keeps us locked in the system of blame and shame, and prevents us from addressing the systemic causes of poverty, wealth-inequality, racism, sexism, educational inequity and the like. My suggestion is that we move beyond this, and acknowledge that the lottery of life is not always fair, that luck does not average out in the long run, and that who we are and what we do is ultimately the result of factors beyond our control.
The info is here.
I clipped out the more social-psychological aspect of the conversation. There is a much broader, philosophical component regarding free will earlier in the conversation.
Saturday, November 3, 2018
Friday, November 2, 2018
Companies Tout Psychiatric Pharmacogenomic Testing, But Is It Ready for a Store Near You?
Jennifer Abbasi
JAMA Network
Originally posted October 3, 2018
Here is an excerpt:
According to Dan Dowd, PharmD, vice president of medical affairs at Genomind, pharmacists in participating stores can inform customers about the Genecept Assay if they notice a history of psychotropic drug switching or drug-related adverse effects. If the test is administered, a physician’s order is required for the company’s laboratory to process it.
“This certainly is a recipe for selling a whole lot more tests,” Potash said of the approach, adding that patients often feel “desperate” to find a successful treatment. “What percentage of the time selling these tests will result in better patient outcomes remains to be seen.”
Biernacka also had reservations about the in-store model. “Generally, it could be helpful for a pharmacist to tell a patient or their provider that perhaps the patient could benefit from pharmacogenetic testing,” she said. “[B]ut until the tests are more thoroughly assessed, the decision to pursue such an option (and with which test) should be left more to the treating clinician and patient.”
Some physicians said they’ve found pharmacogenomic testing to be useful. Aron Fast, MD, a family physician in Hesston, Kansas, uses GeneSight for patients with depression or anxiety who haven’t improved after trying 2 or 3 antidepressants. Each time, he said, his patients were less depressed or anxious after switching to a new drug based on their genotyping results.
Part of their improvements may stem from expecting the test to help, he acknowledged. The testing “raises confidence in the medication to be prescribed,” Müller explained, which might contribute to a placebo effect. However, Müller emphasized that the placebo effect alone is unlikely to explain lasting improvements in patients with moderate to severe depression. In his psychiatric consulting practice, pharmacogenomic-guided drug changes have led to improvements in patients “sometimes even up to the point where they’re completely remitted,” he said.
The info is here.
JAMA Network
Originally posted October 3, 2018
Here is an excerpt:
According to Dan Dowd, PharmD, vice president of medical affairs at Genomind, pharmacists in participating stores can inform customers about the Genecept Assay if they notice a history of psychotropic drug switching or drug-related adverse effects. If the test is administered, a physician’s order is required for the company’s laboratory to process it.
“This certainly is a recipe for selling a whole lot more tests,” Potash said of the approach, adding that patients often feel “desperate” to find a successful treatment. “What percentage of the time selling these tests will result in better patient outcomes remains to be seen.”
Biernacka also had reservations about the in-store model. “Generally, it could be helpful for a pharmacist to tell a patient or their provider that perhaps the patient could benefit from pharmacogenetic testing,” she said. “[B]ut until the tests are more thoroughly assessed, the decision to pursue such an option (and with which test) should be left more to the treating clinician and patient.”
Some physicians said they’ve found pharmacogenomic testing to be useful. Aron Fast, MD, a family physician in Hesston, Kansas, uses GeneSight for patients with depression or anxiety who haven’t improved after trying 2 or 3 antidepressants. Each time, he said, his patients were less depressed or anxious after switching to a new drug based on their genotyping results.
Part of their improvements may stem from expecting the test to help, he acknowledged. The testing “raises confidence in the medication to be prescribed,” Müller explained, which might contribute to a placebo effect. However, Müller emphasized that the placebo effect alone is unlikely to explain lasting improvements in patients with moderate to severe depression. In his psychiatric consulting practice, pharmacogenomic-guided drug changes have led to improvements in patients “sometimes even up to the point where they’re completely remitted,” he said.
The info is here.
Health care, disease care, or killing care?
Hugo Caicedo
Harvard Blogs
Originally published October 1, 2018
Traditional medical practice is rooted in advanced knowledge of diseases, their most appropriate treatment, and adequate proficiency in its applied practice. Notably, today, medical treatment does not typically occur until disease symptoms have manifested. While we now have ways to develop therapies that can halt the progression of some symptomatic diseases, symptomatic solutions are not meant to serve as a cure of disease but palliative treatment of late-stage chronic diseases.
The reactive approach in most medical interventions is magnified in that medicine is prone to errors. In November of 1999, the U.S. National Academy of Science, an organization representing the most highly regarded scientists and physician researchers in the U.S., published the report To Err is Human.
The manuscript noted that medical error was a leading cause of patient deaths killing up to 98,000 people in the U.S. every year. One hypothesis that came up was that patient data was being poorly collected, aggregated, and shared among different hospitals and even within the same health system. Health policies such the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009 and the Affordable Care Act (ACA) in 2010, primarily focused on optimizing clinical and operational effectiveness through the use of health information technology and expansion of government insurance programs, respectively. However, they did not effectively address the issue of medical errors such as poor judgment, mistaken diagnoses, inadequately coordinated care, and incompetent skill that can directly result in patient harm and death.
The blog post is here.
Harvard Blogs
Originally published October 1, 2018
Traditional medical practice is rooted in advanced knowledge of diseases, their most appropriate treatment, and adequate proficiency in its applied practice. Notably, today, medical treatment does not typically occur until disease symptoms have manifested. While we now have ways to develop therapies that can halt the progression of some symptomatic diseases, symptomatic solutions are not meant to serve as a cure of disease but palliative treatment of late-stage chronic diseases.
The reactive approach in most medical interventions is magnified in that medicine is prone to errors. In November of 1999, the U.S. National Academy of Science, an organization representing the most highly regarded scientists and physician researchers in the U.S., published the report To Err is Human.
The manuscript noted that medical error was a leading cause of patient deaths killing up to 98,000 people in the U.S. every year. One hypothesis that came up was that patient data was being poorly collected, aggregated, and shared among different hospitals and even within the same health system. Health policies such the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009 and the Affordable Care Act (ACA) in 2010, primarily focused on optimizing clinical and operational effectiveness through the use of health information technology and expansion of government insurance programs, respectively. However, they did not effectively address the issue of medical errors such as poor judgment, mistaken diagnoses, inadequately coordinated care, and incompetent skill that can directly result in patient harm and death.
The blog post is here.
Thursday, November 1, 2018
Lesion network localization of free will
R. Ryan Darby, Juho Joutsa, Matthew J. Burke, and Michael D. Fox
PNAS
First published October 1, 2018
Abstract
Our perception of free will is composed of a desire to act (volition) and a sense of responsibility for our actions (agency). Brain damage can disrupt these processes, but which regions are most important for free will perception remains unclear. Here, we study focal brain lesions that disrupt volition, causing akinetic mutism (n = 28), or disrupt agency, causing alien limb syndrome (n = 50), to better localize these processes in the human brain. Lesion locations causing either syndrome were highly heterogeneous, occurring in a variety of different brain locations. We next used a recently validated technique termed lesion network mapping to determine whether these heterogeneous lesion locations localized to specific brain networks. Lesion locations causing akinetic mutism all fell within one network, defined by connectivity to the anterior cingulate cortex. Lesion locations causing alien limb fell within a separate network, defined by connectivity to the precuneus. Both findings were specific for these syndromes compared with brain lesions causing similar physical impairments but without disordered free will. Finally, our lesion-based localization matched network localization for brain stimulation locations that disrupt free will and neuroimaging abnormalities in patients with psychiatric disorders of free will without overt brain lesions. Collectively, our results demonstrate that lesions in different locations causing disordered volition and agency localize to unique brain networks, lending insight into the neuroanatomical substrate of free will perception.
The article is here.
PNAS
First published October 1, 2018
Abstract
Our perception of free will is composed of a desire to act (volition) and a sense of responsibility for our actions (agency). Brain damage can disrupt these processes, but which regions are most important for free will perception remains unclear. Here, we study focal brain lesions that disrupt volition, causing akinetic mutism (n = 28), or disrupt agency, causing alien limb syndrome (n = 50), to better localize these processes in the human brain. Lesion locations causing either syndrome were highly heterogeneous, occurring in a variety of different brain locations. We next used a recently validated technique termed lesion network mapping to determine whether these heterogeneous lesion locations localized to specific brain networks. Lesion locations causing akinetic mutism all fell within one network, defined by connectivity to the anterior cingulate cortex. Lesion locations causing alien limb fell within a separate network, defined by connectivity to the precuneus. Both findings were specific for these syndromes compared with brain lesions causing similar physical impairments but without disordered free will. Finally, our lesion-based localization matched network localization for brain stimulation locations that disrupt free will and neuroimaging abnormalities in patients with psychiatric disorders of free will without overt brain lesions. Collectively, our results demonstrate that lesions in different locations causing disordered volition and agency localize to unique brain networks, lending insight into the neuroanatomical substrate of free will perception.
The article is here.
How much control do you really have over your actions?
Michael Price
Sciencemag.org
Originally posted October 1, 2018
Here is an excerpt:
Philosophers have wrestled with questions of free will—that is, whether we are active drivers or passive observers of our decisions—for millennia. Neuroscientists tap-dance around it, asking instead why most of us feel like we have free will. They do this by looking at rare cases in which people seem to have lost it.
Patients with both alien limb syndrome and akinetic mutism have lesions in their brains, but there doesn’t seem to be a consistent pattern. So Darby and his colleagues turned to a relatively new technique known as lesion network mapping.
They combed the literature for brain imaging studies of both types of patients and mapped out all of their reported brain lesions. Then they plotted those lesions onto maps of brain regions that reliably activate together at the same time, better known as brain networks. Although the individual lesions in patients with the rare movement disorders appeared to occur without rhyme or reason, the team found, those seemingly arbitrary locations fell within distinct brain networks.
The researchers compared their results with those from people who lost some voluntary movement after receiving temporary brain stimulation, which uses low-voltage electrodes or targeted magnetic fields to temporarily “knock offline” brain regions.
The networks that caused loss of voluntary movement or agency in those studies matched Darby and colleagues’ new lesion networks. This suggests these networks are involved in voluntary movement and the perception that we’re in control of, and responsible for, our actions, the researchers report today in the Proceedings of the National Academy of Sciences.
The info is here.
Sciencemag.org
Originally posted October 1, 2018
Here is an excerpt:
Philosophers have wrestled with questions of free will—that is, whether we are active drivers or passive observers of our decisions—for millennia. Neuroscientists tap-dance around it, asking instead why most of us feel like we have free will. They do this by looking at rare cases in which people seem to have lost it.
Patients with both alien limb syndrome and akinetic mutism have lesions in their brains, but there doesn’t seem to be a consistent pattern. So Darby and his colleagues turned to a relatively new technique known as lesion network mapping.
They combed the literature for brain imaging studies of both types of patients and mapped out all of their reported brain lesions. Then they plotted those lesions onto maps of brain regions that reliably activate together at the same time, better known as brain networks. Although the individual lesions in patients with the rare movement disorders appeared to occur without rhyme or reason, the team found, those seemingly arbitrary locations fell within distinct brain networks.
The researchers compared their results with those from people who lost some voluntary movement after receiving temporary brain stimulation, which uses low-voltage electrodes or targeted magnetic fields to temporarily “knock offline” brain regions.
The networks that caused loss of voluntary movement or agency in those studies matched Darby and colleagues’ new lesion networks. This suggests these networks are involved in voluntary movement and the perception that we’re in control of, and responsible for, our actions, the researchers report today in the Proceedings of the National Academy of Sciences.
The info is here.
Wednesday, October 31, 2018
We’re Worrying About the Wrong Kind of AI
Mark Buchanan
Bloomberg.com
Originally posted June 11, 2018
No computer has yet shown features of true human-level artificial intelligence much less conscious awareness. Some experts think we won't see it for a long time to come. And yet academics, ethicists, developers and policy-makers are already thinking a lot about the day when computers become conscious; not to mention worries about more primitive AI being used in defense projects.
Now consider that biologists have been learning to grow functioning “mini brains” or “brain organoids” from real human cells, and progress has been so fast that researchers are actually worrying about what to do if a piece of tissue in a lab dish suddenly shows signs of having conscious states or reasoning abilities. While we are busy focusing on computer intelligence, AI may arrive in living form first, and bring with it a host of unprecedented ethical challenges.
In the 1930s, the British mathematician Alan Turing famously set out the mathematical foundations for digital computing. It's less well known that Turing later pioneered the mathematical theory of morphogenesis, or how organisms develop from single cells into complex multicellular beings through a sequence of controlled transformations making increasingly intricate structures. Morphogenesis is also a computation, only with a genetic program controlling not just 0s and 1s, but complex chemistry, physics and cellular geometry.
Following Turing's thinking, biologists have learned to control the computation of biological development so accurately that lab growth of artificial organs, even brains, is no longer science fiction.
The information is here.
Bloomberg.com
Originally posted June 11, 2018
No computer has yet shown features of true human-level artificial intelligence much less conscious awareness. Some experts think we won't see it for a long time to come. And yet academics, ethicists, developers and policy-makers are already thinking a lot about the day when computers become conscious; not to mention worries about more primitive AI being used in defense projects.
Now consider that biologists have been learning to grow functioning “mini brains” or “brain organoids” from real human cells, and progress has been so fast that researchers are actually worrying about what to do if a piece of tissue in a lab dish suddenly shows signs of having conscious states or reasoning abilities. While we are busy focusing on computer intelligence, AI may arrive in living form first, and bring with it a host of unprecedented ethical challenges.
In the 1930s, the British mathematician Alan Turing famously set out the mathematical foundations for digital computing. It's less well known that Turing later pioneered the mathematical theory of morphogenesis, or how organisms develop from single cells into complex multicellular beings through a sequence of controlled transformations making increasingly intricate structures. Morphogenesis is also a computation, only with a genetic program controlling not just 0s and 1s, but complex chemistry, physics and cellular geometry.
Following Turing's thinking, biologists have learned to control the computation of biological development so accurately that lab growth of artificial organs, even brains, is no longer science fiction.
The information is here.
Learning Others’ Political Views Reduces the Ability to Assess and Use Their Expertise in Nonpolitical Domains
Marks, Joseph and Copland, Eloise and Loh, Eleanor and Sunstein, Cass R. and Sharot, Tali.
Harvard Public Law Working Paper No. 18-22. (April 13, 2018).
Abstract
On political questions, many people are especially likely to consult and learn from those whose political views are similar to their own, thus creating a risk of echo chambers or information cocoons. Here, we test whether the tendency to prefer knowledge from the politically like-minded generalizes to domains that have nothing to do with politics, even when evidence indicates that person is less skilled in that domain than someone with dissimilar political views. Participants had multiple opportunities to learn about others’ (1) political opinions and (2) ability to categorize geometric shapes. They then decided to whom to turn for advice when solving an incentivized shape categorization task. We find that participants falsely concluded that politically like-minded others were better at categorizing shapes and thus chose to hear from them. Participants were also more influenced by politically like-minded others, even when they had good reason not to be. The results demonstrate that knowing about others’ political views interferes with the ability to learn about their competency in unrelated tasks, leading to suboptimal information-seeking decisions and errors in judgement. Our findings have implications for political polarization and social learning in the midst of political divisions.
You can download the paper here.
Probably a good resource to contemplate before discussing politics in psychotherapy.
Harvard Public Law Working Paper No. 18-22. (April 13, 2018).
Abstract
On political questions, many people are especially likely to consult and learn from those whose political views are similar to their own, thus creating a risk of echo chambers or information cocoons. Here, we test whether the tendency to prefer knowledge from the politically like-minded generalizes to domains that have nothing to do with politics, even when evidence indicates that person is less skilled in that domain than someone with dissimilar political views. Participants had multiple opportunities to learn about others’ (1) political opinions and (2) ability to categorize geometric shapes. They then decided to whom to turn for advice when solving an incentivized shape categorization task. We find that participants falsely concluded that politically like-minded others were better at categorizing shapes and thus chose to hear from them. Participants were also more influenced by politically like-minded others, even when they had good reason not to be. The results demonstrate that knowing about others’ political views interferes with the ability to learn about their competency in unrelated tasks, leading to suboptimal information-seeking decisions and errors in judgement. Our findings have implications for political polarization and social learning in the midst of political divisions.
You can download the paper here.
Probably a good resource to contemplate before discussing politics in psychotherapy.
Tuesday, October 30, 2018
How Trump’s Hateful Speech Raises the Risks of Violence
Cass Sunstein
Bloomberg.com
Originally posted October 28, 2018
Here is an excerpt:
Is President Donald Trump responsible, in some sense, for the mailing of bombs to Hillary Clinton and other Democratic leaders? Is he responsible, in some sense, for the slaughter at the Pittsburgh synagogue?
If we are speaking in terms of causation, the most reasonable answer to both questions, and the safest, is: We don’t really know. More specifically, we don’t know whether these particular crimes would have occurred in the absence of Trump’s hateful and vicious rhetoric (including his enthusiasm for the despicable cry, “Lock her up!”).
But it’s also safe, and plenty reasonable, to insist that across the American population, hateful and vicious rhetoric from the president of the United States is bound to increase risks of violence. Because of that rhetoric, the likelihood of this kind of violence is greater than it would otherwise be. The president is responsible for elevating the risk that people will try to kill Democrats and others seen by some of his followers as “enemies of the people” (including journalists and Jews).
To see why, we should investigate one of the most striking findings in modern social psychology that has been replicated on dozens of occasions. It goes by the name of “group polarization.”
The basic idea is that when people are listening and talking to one another, they tend to end up in a more extreme position in the same direction of the views with which they began. Groups of like-minded people can become radicalized.
The info is here.
Bloomberg.com
Originally posted October 28, 2018
Here is an excerpt:
Is President Donald Trump responsible, in some sense, for the mailing of bombs to Hillary Clinton and other Democratic leaders? Is he responsible, in some sense, for the slaughter at the Pittsburgh synagogue?
If we are speaking in terms of causation, the most reasonable answer to both questions, and the safest, is: We don’t really know. More specifically, we don’t know whether these particular crimes would have occurred in the absence of Trump’s hateful and vicious rhetoric (including his enthusiasm for the despicable cry, “Lock her up!”).
But it’s also safe, and plenty reasonable, to insist that across the American population, hateful and vicious rhetoric from the president of the United States is bound to increase risks of violence. Because of that rhetoric, the likelihood of this kind of violence is greater than it would otherwise be. The president is responsible for elevating the risk that people will try to kill Democrats and others seen by some of his followers as “enemies of the people” (including journalists and Jews).
To see why, we should investigate one of the most striking findings in modern social psychology that has been replicated on dozens of occasions. It goes by the name of “group polarization.”
The basic idea is that when people are listening and talking to one another, they tend to end up in a more extreme position in the same direction of the views with which they began. Groups of like-minded people can become radicalized.
The info is here.
West Virginia Poll examines moral and social issues
Brad McElhinnywvmetronews.com
Originally posted September 30, 2018
Here is an excerpt:
Role of God in morality
There was a 50-50 split in a question asking respondents to select the statement that best reflects their view of the role of God in morality.
Half responded, “It is not necessary to believe in God in order to be moral and have good values.”
The other half of respondents chose the option “It is necessary to believe in God in order to be moral and have good values.”
“The two big, significant differences are younger people and self-identified conservatives who have opposite points of view on this question,” said professional pollster Rex Repass, the author of the West Virginia Poll.
Of younger people — those between ages 18 and 34 — 60 percent said it’s not necessary to believe in God to have good moral and ethical values.
That compared to 35 percent of those ages 55-64 who answered with that statement.
“So generally, if you’re under 35, you’re more likely to say it’s not necessary to say have a higher being in your life to have good values,” Repass said.
“If you’re older that percentage increases. You’re more likely to believe you have to have God in your life to be moral and have good values.”
Of respondents who labeled themselves as conservative, 73 percent said it is necessary to believe in God to have moral values.
The info is here.
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