A Missed Opportunity for the Malpractice System to Improve Health Care

Aaron Carroll
The New York Times
Originally posted May 27, 2019

Here are two excerpts:

First, the good news: These doctors quit at higher rates than other physicians. And they also tend not to pick up and move somewhere else to start fresh (which many thought they’d do given that licenses and malpractice are regulated at the state level).

But the overwhelming majority of doctors who had five or more paid claims kept on going. And they also moved to solo practice and small groups more often, where there’s even less oversight, so those problematic doctors may produce even worse outcomes.

We have long known that some doctors are likelier than others to be sued. Those who practice in certain higher-risk specialties — like surgery, obstetrics and gynecology, and emergency medicine — are more likely to be sued than those in lower-risk specialties like family medicine, pediatrics and psychiatry. Men are more likely to be sued than women. Lawsuits seem to peak when doctors are around 40.

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Those who accumulated more claims were more likely to stop practicing medicine. Even though they were more likely to retire, more than 90 percent of doctors who had at least five claims were still in practice.

Physicians with more claims were also not any more likely than those with fewer or no complaints to move to another state and continue practicing. This is actually one of the reasons the practitioner data bank was created — to prevent doctors from running away from their history by moving between states. In that respect, it appears to be working.

What’s worrisome, though, is that physicians with more claims shifted their type of practice. Those with five or more claims had more than twice the odds of moving into solo practice.

The info is here.

Does evolutionary biology contribute to ethics?

Bateson, P.
Biol Philos (1989) 4: 287.
https://doi.org/10.1007/BF02426629

Abstract

Human propensities that are the products of Darwinian evolution may combine to generate a form of social behavior that is not itself a direct result of such pressure. This possibility may provide a satisfying explanation for the origin of socially transmitted rules such as the incest taboo. Similarly, the regulatory processes of development that generated adaptations to the environment in the circumstances in which they evolved can produce surprising and sometimes maladaptive consequences for the individual in modern conditions. These combinatorial aspects of social and developmental dynamics leave a subtle but not wholly uninteresting role for evolutionary biology in explaining the origins of human morality.

German ethics council expresses openness to eventual embryo editing

Sharon Begley
www.statnews.com
Originally posted May 13, 2019

Here is an excerpt:

The council’s openness to human germline editing was notable, however. Because of the Nazis’ eugenics programs and horrific human medical experiments, Germany has historically been even warier than other Western countries of medical technologies that might violate human dignity or could be exploited for eugenic purposes. The country’s 1990 Embryo Protection Act prohibits germline modifications for the purpose of reproduction.

“Germany has been very reluctant to get involved with anything that could lead to a re-introduction of eugenic practices in their society,” Annas said.

Despite that history, a large majority of the council called further development and possible use of germline editing “a legitimate ethical goal when aimed at avoiding or reducing genetically determined disease risks,” it said in a statement. If the procedure can be shown not to harm embryos or the children they become, it added, then altering a gene that otherwise causes a devastating illness such as cystic fibrosis or sickle cell is acceptable.

While some ethicists and others argue against embryo editing on the ground that it violates the embryos’ dignity, the German council wrote, “the question also arises as to whether the renunciation of germline intervention, which could spare the people concerned severe suffering, would not violate their human dignity, too.” Similarly, failing to intervene in order to spare a future child pain and suffering “would at least have to be justified,” the council said, echoing arguments that some families with a history of inherited diseases have.

The info is here.

Anger, Fear, and Echo Chambers: The Emotional Basis for Online Behavior

Wollebæk, D., Karlsen, R., Steen-Johnsen, K., & Enjolras, B.
(2019). Social Media + Society. 
https://doi.org/10.1177/2056305119829859

Abstract

Emotions, such as anger and fear, have been shown to influence people’s political behavior. However, few studies link emotions specifically to how people debate political issues and seek political information online. In this article, we examine how anger and fear are related to politics-oriented digital behavior, attempting to bridge the gap between the thus far disconnected literature on political psychology and the digital media. Based on survey data, we show that anger and fear are connected to distinct behaviors online. Angry people are more likely to engage in debates with people having both similar and opposing views. They also seek out information confirming their views more frequently. Anxious individuals, by contrast, tend to seek out information contradicting their opinions. These findings reiterate predictions made in the extant literature concerning the role of emotions in politics. Thus, we argue that anger reinforces echo chamber dynamics and trench warfare dynamics in the digital public sphere, while fear counteracts these dynamics.

Discussion and Conclusion

The analyses have shown that anger and fear have distinct effects on echo chamber and trench warfare dynamics in the digital sphere. With regard to the debate dimension, we have shown that anger is positively related to participation in online debates. This finding confirms the results of a recent study by Hasell and Weeks (2016). Importantly, however, the impact of anger is not limited to echo chamber discussions with like-minded and similar people. Angry individuals are also over-represented in debates between people holding opposing views and belonging to a different class or
ethnic background. This entails that regarding online debates, anger contributes more to what has been previously labeled as trench warfare dynamics than to echo chamber dynamics.

The research is here.

Trading morality for a good economy

Michael Gerson
www.dailyherald.com
Originally posted May 28, 2019

Here is an excerpt:

Bennett went on to talk about how capitalism itself depends on good private character; how our system of government requires leaders of integrity; how failings of character can't be neatly compartmentalized. "A president whose character manifests itself in patterns of reckless personal conduct, deceit, abuse of power and contempt for the rule of law," he wrote, "cannot be a good president."

Above all, Bennett argued that the cultivation of character depends on the principled conduct of those in positions of public trust. "During moments of crisis," he wrote, "of unfolding scandal, people watch closely. They learn from what they see. And they often embrace a prevailing attitude and ethos, and employ what seems to work for others. So it matters if the legacy of the president is that the ends justify the means; that rules do not apply across the board; that lawlessness can be excused. It matters, too, if we demean the presidency by lowering our standards of expectations for the office and by redefining moral authority down. It matters if truth becomes incidental, and public office is used to cover up misdeeds. And it matters if we treat a president as if he were a king, above the law."

All this was written while Bill Clinton was president. And Bennett himself now seems reluctant to apply these rules "across the board" to a Republican president. This is not unusual. It is the political norm to ignore the poor character of politicians we agree with. But this does nothing to discredit Bennett's argument.

If you are a sexual harasser who wants to escape consequences, or a businessperson who habitually plays close to ethical lines, your hour has come. If you dream of having a porn-star mistress, or hope to game the tax system for your benefit, you have found your man and your moment. For all that is bent and sleazy, for all that is dishonest and dodgy, these are the golden days.

The info is here.

Cameras Everywhere: The Ethics Of Eyes In The Sky

Tom Vander Ark
Forbes.com
Originally posted May 8, 2019

Pictures from people's houses can predict the chances of that person getting into a car accident. The researchers that created the system acknowledged that "modern data collection and computational techniques...allow for unprecedented exploitation of personal data, can outpace development of legislation and raise privacy threats."

Hong Kong researchers created a drone system that can automatically analyze a road surface. It suggests that we’re approaching the era of automated surveillance for civil and military purposes.

In lower Manhattan, police are planning a surveillance center where officers can view thousands of video cameras around the downtown.


Microsoft turned down the sale of facial recognition software to California law enforcement arguing that innocent women and minorities would be disproportionately held for questioning. It suggests that the technology is running ahead of public policy but not ready for equitable use. 

And speaking of facial recognition, Jet Blue has begun using it in lieu of boarding passes on some flights much to the chagrin of some passengers who wonder when they gave consent for this application and who has access to what biometric data.

The info is here.

A socio-historical take on the meta-problem of consciousness

Hakwan Lau and Matthias Michel
PsyArXiv Preprints
Last Edited May 21, 2019

Abstract

Whether consciousness is hard to explain depends on the notion of explanation at play. Importantly, for an explanation to be successful, it is necessary to have a correct understanding of the relevant basic empirical facts (i.e. the explanans). We review socio-historical factors that account for why, as a field, the neuroscience of consciousness has not been particularly successful at getting the basic facts right. And yet, we tend to aim for explanations of an unrealistically and unnecessarily ambitious nature. This discrepancy between ambitious notions of explanations and the relatively poor quality of explanans may account for what Chalmers calls “the meta-problem”.

The paper is here.

What's Behind A Rise In Conscience Complaints For Health Care Workers?

Selena Simmons-Duffin
NPR
Originally posted May 9, 2019

When health care workers feel they have been forced to do something they disagree with on moral or religious grounds, they can file complaints with the Department of Health and Human Services' Office for Civil Rights. Some high-profile cases have involved nurses who objected to providing abortion services.

For a decade, the agency got an average of one of these complaints of conscience violations each year. The complaints can include doctors, nurses or other health care workers who feel a hospital or clinic that receives federal funds has discriminated against them because of their moral position. Groups of health care providers also can file complaints.

Last year, the number of complaints jumped to 343.

That increase was cited by the Office of Civil Rights as one reason for issuing a new rule designed to protect conscience rights, unveiled publicly last week. HHS estimates that implementing and enforcing the rule will cost taxpayers $312 million in its first year.

But why did the number of complaints increase?

HHS declined to offer any specifics on the 343 complaints, such as where they were from or what might be behind the sudden increase over past years.

The info is here.

Ethics questions about President Trump's transportation secretary surface for second week in a row

Matthew Rozsa
www.salon.com
Originally posted June 3, 2019

Here is an excerpt:

After ethics questions were referred to officials in the State and Treasury Departments, and media outlets like Times began to look into Chao's unusual travel requests, the trip was cancelled.

"She had these relatives who were fairly wealthy and connected to the shipping industry. Their business interests were potentially affected by meetings," a State Department official, who was involved in deliberations pertaining to the meetings, told the Times. Another State Department official, David Rank, told the Times the requests were "alarmingly inappropriate."

Chao's family runs an American shipping company, the Foremost Group, which is connected to China's political and economic ruling class, since it conducts most of its business there. As a result, allowing family members to participate in sensitive meetings — especially considering that Chao's actions as transportation secretary could directly impact America's shipping industry, and goes to the heart of the U.S.-China trade policies being handled by the Trump administration — poses a major conflict of interest.

The info is here.