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, November 5, 2018

Bolton says 'excessive' ethics checks discourage outsiders from joining government

Nicole Gaouette
CNN.com
Originally posted October 31, 2018

A day after CNN reported that the Justice Department is investigating whether Interior Secretary Ryan Zinke has broken the law by using his office to personally enrich himself, national security adviser John Bolton told the Hamilton Society in Washington that ethics rules make it hard for people outside of the government to serve.

Bolton said "things have gotten more bureaucratic, harder to get things done" since he served under President George H.W. Bush in the 1990s and blamed the difficulty, in part, on the "excessive nature of the so-called ethics checks."

"If you were designing a system to discourage people from coming into government, you would do it this way," Bolton said.

"That risks building up a priestly class" of government employees, he added.

"It's really depressing to see," Bolton said of the bureaucratic red tape.

The info is here.

My take: Mr. Bolton is wrong.  We need rigorous ethical guidelines, transparency, enforceability, and thorough background checks.  Otherwise, the swamp will grow much greater than it already is.

We Need To Examine The Ethics And Governance Of Artificial Intelligence

Nikita Malik
forbes.com
Originally posted October 4, 2018

Here is an excerpt:

The second concern is on regulation and ethics. Research teams at MIT and Harvard are already looking into the fast-developing area of AI to map the boundaries within which sensitive but important data can be used. Who determines whether this technology can save lives, for example, versus the very real risk of veering into an Orwellian dystopia?

Take artificial intelligence systems that have the ability to predicate a crime based on an individual’s history, and their propensity to do harm. Pennsylvania could be one of the first states in the United States to base criminal sentences not just on the crimes people are convicted of, but also on whether they are deemed likely to commit additional crimes in the future. Statistically derived risk assessments – based on factors such as age, criminal record, and employment, will help judges determine which sentences to give. This would help reduce the cost of, and burden on, the prison system.

Risk assessments – which have existed for a long time - have been used in other areas such as the prevention of terrorism and child sexual exploitation. In the latter category, existing human systems are so overburdened that children are often overlooked, at grave risk to themselves. Human errors in the case work of the severely abused child Gabriel Fernandez contributed to his eventual death at the hands of his parents, and a serious inquest into the shortcomings of the County Department of Children and Family Services in Los Angeles. Using artificial intelligence in vulnerability assessments of children could aid overworked caseworkers and administrators and flag errors in existing systems.

The info is here.

Sunday, November 4, 2018

When Tech Knows You Better Than You Know Yourself

Nicholas Thompson
www.wired.com
Originally published October 4, 2018

Here is an excerpt:

Hacking a Human

NT: Explain what it means to hack a human being and why what can be done now is different from what could be done 100 years ago.

YNH: To hack a human being is to understand what's happening inside you on the level of the body, of the brain, of the mind, so that you can predict what people will do. You can understand how they feel and you can, of course, once you understand and predict, you can usually also manipulate and control and even replace. And of course it can't be done perfectly and it was possible to do it to some extent also a century ago. But the difference in the level is significant. I would say that the real key is whether somebody can understand you better than you understand yourself. The algorithms that are trying to hack us, they will never be perfect. There is no such thing as understanding perfectly everything or predicting everything. You don't need perfect, you just need to be better than the average human being.

If you have an hour, please watch the video.

Saturday, November 3, 2018

Just deserts

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.

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.

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.

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.

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.

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.