You Snooze, You Lose: Insurers Make The Old Adage Literally True

Justin Volz
ProPublica

Originally published November 21, 2018

Here is an excerpt:

In fact, faced with the popularity of CPAPs, which can cost $400 to $800, and their need for replacement filters, face masks and hoses, health insurers have deployed a host of tactics that can make the therapy more expensive or even price it out of reach.

Patients have been required to rent CPAPs at rates that total much more than the retail price of the devices, or they’ve discovered that the supplies would be substantially cheaper if they didn’t have insurance at all.

Experts who study health care costs say insurers’ CPAP strategies are part of the industry’s playbook of shifting the costs of widely used therapies, devices and tests to unsuspecting patients.

“The doctors and providers are not in control of medicine anymore,” said Harry Lawrence, owner of Advanced Oxy-Med Services, a New York company that provides CPAP supplies. “It’s strictly the insurance companies. They call the shots.”

Insurers say their concerns are legitimate. The masks and hoses can be cumbersome and noisy, and studies show that about third of patients don’t use their CPAPs as directed.

But the companies’ practices have spawned lawsuits and concerns by some doctors who say that policies that restrict access to the machines could have serious, or even deadly, consequences for patients with severe conditions. And privacy experts worry that data collected by insurers could be used to discriminate against patients or raise their costs.

The info is here.

Therapy Is No Longer a Politics-Free Zone

Peggy Drexler
The Wall Street Journal
Originally posted November November 23, 2018

Here is an excerpt:

A May 2018 survey published in the Journal of Clinical Psychology—which devoted an entire issue to how mental health professionals can understand and deal with the dramatic increase in clients feeling politics-related anxiety—found that of 604 psychotherapy patients from 50 states, only 32 percent said their therapist didn’t disclose their political beliefs, while 30 percent said their therapists divulged their views and the other 38 percent said their therapists very clearly made their beliefs known. “The old rules are pretty straightforward: Don’t talk about it,” says Dr. Steven Schlozman. a psychiatrist at Massachusetts General Hospital in Boston. “But our country right now is so about what side you’re on that almost every interaction people have these days is characterized by that.”

Full disclosure may be surprising, but it isn’t necessarily unwelcome. A 2018 poll conducted by market research firm Branded Research found that 61 percent of more than 8,000 therapy patients surveyed say it is “very” or “somewhat” important that they and their therapist share the same political values. Manhattan clinical psychologist Sarah Gundle, the co-clinical director of Octave, a “behavioral health studio” that opened in October offering individual and group therapy—including support groups for those feeling politics-related stress or anxiety—recalls a recent patient who wanted to know where she stood.

The info is here.

Medical Ethicist Calls Trump Approved Medicaid Work Requirements Cruel

Jason Turesky
www.wgbh.org
Originally posted November 26, 2018

Here is an excerpt:

Medical ethicist Art Caplan called the idea of Medicaid work requirements “cruel” on Boston Public Radio Monday, and believes there are no clear benefits to these new rules. “It’s not really something that I think is going to instill good habits or get people off Medicaid,” Caplan said.

Caplan pointed out that many of the people on Medicaid in Kentucky may not be physically able to fulfill the 80 hour requirement.

“Remember, the overwhelming majority of people on Medicaid in Kentucky, and every state, are disabled or children or single head of household females, so getting them out 80 hours per month to do anything is very difficult, unless we are going to re-institute child labor,” he said.

The info is here.

Your Intuition Is Wrong, Unless These 3 Conditions Are Met

Emily Zulz
www.thinkadvisor.com
Originally posted November 16, 2018

Here is an excerpt:

“Intuitions of master chess players when they look at the board [and make a move], they’re accurate,” he said. “Everybody who’s been married could guess their wife’s or their husband’s mood by one word on the telephone. That’s an intuition and it’s generally very good, and very accurate.”

According to Kahneman, who’s studied when one can trust intuition and when one cannot, there are three conditions that need to be met in order to trust one’s intuition.

The first is that there has to be some regularity in the world that someone can pick up and learn.

“So, chess players certainly have it. Married people certainly have it,” Kahnemen explained.

However, he added, people who pick stocks in the stock market do not have it.

“Because, the stock market is not sufficiently regular to support developing that kind of expert intuition,” he explained.

The second condition for accurate intuition is “a lot of practice,” according to Kahneman.

And the third condition is immediate feedback. Kahneman said that “you have to know almost immediately whether you got it right or got it wrong.”

The info is here.

Fresh urgency in mapping out ethics of brain organoid research

Julian Koplin and Julian Savulescu
The Conversation
Originally published November 20, 2018

Here is an excerpt:

But brain organoid research also raises serious ethical questions. The main concern is that brain organoids could one day attain consciousness – an issue that has just been brought to the fore by a new scientific breakthrough.

Researchers from the University of California, San Diego, recently published the creation of brain organoids that spontaneously produce brain waves resembling those found in premature infants. Although this electrical activity does not necessarily mean these organoids are conscious, it does show that we need to think through the ethics sooner rather than later.

Regulatory gaps

Stem cell research is already subject to careful regulation. However, existing regulatory frameworks have not yet caught up with the unique set of ethical concerns associated with brain organoids.

Guidelines like the National Health and Medical Research Council’s National Statement on Ethical Conduct in Human Research protect the interests of those who donate human biological material to research (and also address a host of other issues). But they do not consider whether brain organoids themselves could acquire morally relevant interests.

This gap has not gone unnoticed. A growing number of commentators argue that brain organoid research should face restrictions beyond those that apply to stem cell research more generally. Unfortunately, little progress has been made on identifying what form these restrictions should take.

The info is here.

Complexities for Psychiatry's Identity As a Medical Specialty

Mohammed Abouelleil Rashed
Kan Zaman Blog
Originally posted November 23, 2018

Here is an excerpt:

Doctors, researchers, governments, pharmaceutical companies, and patient groups each have their own interests and varying abilities to influence the construction of disease categories. This creates the possibility for disagreement over the legitimacy of certain conditions, something we can see playing out in the ongoing debates surrounding Chronic Fatigue Syndrome, a condition that “receives much more attention from its sufferers and their supporters than from the medical community” (Simon 2011: 91). And, in psychiatry, it has long been noted that some major pharmaceutical companies influence the construction of disorder in order to create a market for the psychotropic drugs they manufacture. From the perspective of medical anti-realism (in the constructivist form presented here), these influences are no longer seen as a hindrance to the supposedly objective, ‘natural kind’ status of disease categories, but as key factors involved in their construction. Thus, the lobbying power of the American Psychiatric Association, the vested interests of pharmaceutical companies, and the desire of psychiatrists as a group to maintain their prestige do not undermine the identity of psychiatry as a medical specialty; what they do is highlight the importance of emphasizing the interests of patient groups as well as utilitarian and economic criteria to counteract and respond to the other interests. Medical constructivism is not a uniquely psychiatric ontology, it is a medicine-wide ontology; it applies to schizophrenia as it does to hypertension, appendicitis, and heart disease. Owing to the normative complexity of psychiatry (outlined earlier) and to the fact that loss of freedom is often involved in psychiatric practice, the vested interests involved in psychiatry are more complex and harder to resolve than in many other medical specialties. But that in itself is not a hindrance to psychiatry’s identity as a medical speciality.

The info is here.

You can’t characterize human nature if studies overlook 85 percent of people on Earth

Daniel Hruschka
The Conversation
Originally posted November 16, 2108

Here is an excerpt:

To illustrate the extent of this bias, consider that more than 90 percent of studies recently published in psychological science’s flagship journal come from countries representing less than 15 percent of the world’s population.

If people thought and behaved in basically the same ways worldwide, selective attention to these typical participants would not be a problem. Unfortunately, in those rare cases where researchers have reached out to a broader range of humanity, they frequently find that the “usual suspects” most often included as participants in psychology studies are actually outliers. They stand apart from the vast majority of humanity in things like how they divvy up windfalls with strangers, how they reason about moral dilemmas and how they perceive optical illusions.

Given that these typical participants are often outliers, many scholars now describe them and the findings associated with them using the acronym WEIRD, for Western, educated, industrialized, rich and democratic.

The info is here.

Life on the slippery Earth

Sebastian Purcell
aeon.co
Originally posted July 3, 2018

Here is an excerpt:

At its core, Aztec virtue ethics has three main elements. One is a conception of the good life as the ‘rooted’ or worthwhile life. Second is the idea of right action as the mean or middle way. Third and final is the belief that virtue is a quality that’s fostered socially.

When I speak about the Aztecs – the people dominant in large parts of central America prior to the 16th-century Spanish conquest – even professional philosophers are often surprised to learn that the Aztecs were a philosophical culture. They’re even more startled to hear that we have (many volumes of) their texts recorded in their native language, Nahuatl. While a few of the pre-colonial hieroglyphic-type books survived the Spanish bonfires, our main sources of knowledge derive from records made by Catholic priests, up to the early 17th century. Using the Latin alphabet, these texts record the statements of tlamatinime, the indigenous philosophers, on matters as diverse as bird-flight patterns, moral virtue, and the structure of the cosmos.

To explain the Aztec conception of the good life, it’s helpful to begin in the sixth volume of a book called the Florentine Codex, compiled by Father Bernardino of Sahagún. Most of the text contains edifying discourses called huehuetlatolli, the elders’ discourses. This particular section records the speeches following the appointment of a new king, when the noblemen appear to compete for the most eloquent articulation of what an ideal monarch should be and do. The result is a succession of speeches like those in Plato’s Symposium, wherein each member tries to produce the most moving expression of praise.

The info is here.

Enhancement and desert

Thomas Douglas
Politics, Philosophy & Economics
https://doi.org/10.1177/1470594X18810439

Abstract

It is sometimes claimed that those who succeed with the aid of enhancement technologies deserve the rewards associated with their success less, other things being equal, than those who succeed without the aid of such technologies. This claim captures some widely held intuitions, has been implicitly endorsed by participants in social–psychological research and helps to undergird some otherwise puzzling philosophical objections to the use of enhancement technologies. I consider whether it can be provided with a rational basis. I examine three arguments that might be offered in its favour and argue that each either shows only that enhancements undermine desert in special circumstances or succeeds only under assumptions that deprive the appeal to desert of much of its dialectic interest.