Groundbreaking Court Ruling Against Insurer Offers Hope in 2020

Katherine G. Kennedy
Psychiatric News
Originally posted 9 Jan 20

Here is an excerpt:

In his 106-page opinion, Judge Spero criticized UBH for using flawed, internally developed, and overly restrictive medical necessity guidelines that favored protecting the financial interests of UBH over medical treatment of its members.

“By a preponderance of the evidence,” Judge Spero wrote, “in each version of the Guidelines at issue in this case the defect is pervasive and results in a significantly narrower scope of coverage than is consistent with generally accepted standards of care.” His full decision can be accessed here.

As of this writing, we are still awaiting Judge Spero’s remedies order (a court-ordered directive that requires specific actions, such as reparations) against UBH. Following that determination, we will know what UBH will be required to do to compensate class members who suffered damages (that is, protracted illness or death) or their beneficiaries as a result of UBH’s denial of their coverage claims.

But waiting for the remedies order does not prevent us from looking for answers to critical questions like these:

• Will Wit. v. UBH impact the insurance industry enough to catalyze widespread reforms in how utilization review guidelines are determined and used?

• How will the 50 offices of state insurance commissioners respond? Will these regulators mandate the use of clinical coverage guidelines that reflect the findings in Wit. v. UBH? Will they tighten their oversight with updated regulations and enforcement actions?

The info is here.

FDA and NIH let clinical trial sponsors keep results secret and break the law

Charles Piller
sciencemag.org
Originally posted 13 Jan 20

For 20 years, the U.S. government has urged companies, universities, and other institutions that conduct clinical trials to record their results in a federal database, so doctors and patients can see whether new treatments are safe and effective. Few trial sponsors have consistently done so, even after a 2007 law made posting mandatory for many trials registered in the database. In 2017, the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) tried again, enacting a long-awaited “final rule” to clarify the law’s expectations and penalties for failing to disclose trial results. The rule took full effect 2 years ago, on 18 January 2018, giving trial sponsors ample time to comply. But a Science investigation shows that many still ignore the requirement, while federal officials do little or nothing to enforce the law.

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Contacted for comment, none of the institutions disputed the findings of this investigation. In all 4768 trials Science checked, sponsors violated the reporting law more than 55% of the time. And in hundreds of cases where the sponsors got credit for reporting trial results, they have yet to be publicly posted because of quality lapses flagged by ClinicalTrials.gov staff.

The info is here.

Judge holds Pa. psychologist in contempt, calls her defiance ‘extraordinary’ in trucker’s case

John Beague
PennLive.com
Originally 18 Jan 20

A federal judge has held a Sunbury psychologist in contempt and sanctioned her $8,288 for failing to comply with a subpoena and a court order in a civil case stemming from a 2016 traffic crash.

U.S. Middle District Judge Matthew W. Brann, in an opinion issued Friday, said he has never encountered the “obstinance” displayed by Donna Pinter of Psychological Services Clinic Inc.

He called Pinter’s defiance “extraordinary” and pointed out that she never objected to the validity of the subpoena or court order and did not provide an adequate excuse.

“She forced the parties and this court to waste significant and limited resources litigating these motions and convening two hearings for what should have been a routine document production,” he wrote.

The defendants sought information about Kenneth Kerlin of Middleburg from Pinter because she has treated him for years and in his suit he claims the crash, which involved two tractor-trailers, has caused him mental suffering.

The info is here.

Empirical Work in Moral Psychology

Joshua May
Routledge Encyclopedia of Philosophy
Taylor and Francis
Originally published in 2017

Abstract

How do we form our moral judgments, and how do they influence behaviour? What ultimately motivates kind versus malicious action? Moral psychology is the interdisciplinary study of such questions about the mental lives of moral agents, including moral thought, feeling, reasoning and motivation. While these questions can be studied solely from the armchair or using only empirical tools, researchers in various disciplines, from biology to neuroscience to philosophy, can address them in tandem. Some key topics in this respect revolve around moral cognition and motivation, such as moral responsibility, altruism, the structure of moral motivation, weakness of will, and moral intuitions. Of course there are other important topics as well, including emotions, character, moral development, self-deception, addiction, well-being, and the evolution of moral capacities.

Some of the primary objects of study in moral psychology are the processes driving moral action. For example, we think of ourselves as possessing free will, as being responsible for what we do; as capable of self-control; and as capable of genuine concern for the welfare of others. Such claims can be tested by empirical methods to some extent in at least two ways. First, we can determine what in fact our ordinary thinking is. While many philosophers investigate this through rigorous reflection on concepts, we can also use the empirical methods of the social sciences. Second, we can investigate empirically whether our ordinary thinking is correct or illusory. For example, we can check the empirical adequacy of philosophical theories, assessing directly any claims made about how we think, feel, and behave

Understanding the psychology of moral individuals is certainly interesting in its own right, but it also often has direct implications for other areas of ethics, such as metaethics and normative ethics. For instance, determining the role of reason versus sentiment in moral judgment and motivation can shed light on whether moral judgments are cognitive, and perhaps whether morality itself is in some sense objective. Similarly, evaluating moral theories, such as deontology and utilitarianism, often relies on intuitive judgments about what one ought to do in various hypothetical cases. Empirical research can again serve as an additional tool to determine what exactly our intuitions are and which psychological processes generate them, contributing to a rigorous evaluation of the warrant of moral intuitions.

The info is here.

How to build ethical AI

Carolyn Herzog
thehill.com
Originally posted 18 Jan 20

Here is an excerpt:

Any standard-setting in this field must be rooted in the understanding that data is the lifeblood of AI. The continual input of information is what fuels machine learning, and the most powerful AI tools require massive amounts of it. This of course raises issues of how that data is being collected, how it is being used, and how it is being safeguarded.

One of the most difficult questions we must address is how to overcome bias, particularly the unintentional kind. Let’s consider one potential application for AI: criminal justice. By removing prejudices that contribute to racial and demographic disparities, we can create systems that produce more uniform sentencing standards. Yet, programming such a system still requires weighting countless factors to determine appropriate outcomes. It is a human who must program the AI, and a person’s worldview will shape how they program machines to learn. That’s just one reason why enterprises developing AI must consider workforce diversity and put in place best practices and control for both intentional and inherent bias.

This leads back to transparency.

A computer can make a highly complex decision in an instant, but will we have confidence that it’s making a just one?

Whether a machine is determining a jail sentence, or approving a loan, or deciding who is admitted to a college, how do we explain how those choices were made? And how do we make sure the factors that went into that algorithm are understandable for the average person?

The info is here.

The Americans dying because they can't afford medical care

Michael Sainato
theguardian.com
Originally posted 7 Jan 2020

Here is an excerpt:

Finley is one of millions of Americans who avoid medical treatment due to the costs every year.

A December 2019 poll conducted by Gallup found 25% of Americans say they or a family member have delayed medical treatment for a serious illness due to the costs of care, and an additional 8% report delaying medical treatment for less serious illnesses. A study conducted by the American Cancer Society in May 2019 found 56% of adults in America report having at least one medical financial hardship, and researchers warned the problem is likely to worsen unless action is taken.

Dr Robin Yabroff, lead author of the American Cancer Society study, said last month’s Gallup poll finding that 25% of Americans were delaying care was “consistent with numerous other studies documenting that many in the United States have trouble paying medical bills”.

US spends the most on healthcare

Despite millions of Americans delaying medical treatment due to the costs, the US still spends the most on healthcare of any developed nation in the world, while covering fewer people and achieving worse overall health outcomes. A 2017 analysis found the United States ranks 24th globally in achieving health goals set by the United Nations. In 2018, $3.65tn was spent on healthcare in the United States, and these costs are projected to grow at an annual rate of 5.5% over the next decade.

The info is here.

Can Robots Reduce Racism And Sexism?

Kim Elsesser
Forbes.com
Originally posted 16 Jan 20

Robots are becoming a regular part of our workplaces, serving as supermarket cashiers and building our cars. More recently they’ve been tackling even more complicated tasks like driving and sensing emotions. Estimates suggest that about half of the work humans currently do will be automated by 2055, but there may be a silver lining to the loss of human jobs to robots. New research indicates that robots at work can help reduce prejudice and discrimination.

Apparently, just thinking about robot workers leads people to think they have more in common with other human groups according to research published in American Psychologist. When the study participants’ awareness of robot workers increased, they became more accepting of immigrants and people of a different religion, race, and sexual orientation.

Basically, the robots reduced prejudice by highlighting the existence of a group that is not human. Study authors, Joshua Conrad Jackson, Noah Castelo and Kurt Gray, summarized, “The large differences between humans and robots may make the differences between humans seem smaller than they normally appear. Christians and Muslims have different beliefs, but at least both are made from flesh and blood; Latinos and Asians may eat different foods, but at least they eat.” Instead of categorizing people by race or religion, thinking about robots made participants more likely to think of everyone as belonging to one human category.

The info is here.

The medications that change who we are

Zaria Gorvett
BBC.com
Originally published 8 Jan 20

Here are two excerpts:

According to Golomb, this is typical – in her experience, most patients struggle to recognise their own behavioural changes, let alone connect them to their medication. In some instances, the realisation comes too late: the researcher was contacted by the families of a number of people, including an internationally renowned scientist and a former editor of a legal publication, who took their own lives.

We’re all familiar with the mind-bending properties of psychedelic drugs – but it turns out ordinary medications can be just as potent. From paracetamol (known as acetaminophen in the US) to antihistamines, statins, asthma medications and antidepressants, there’s emerging evidence that they can make us impulsive, angry, or restless, diminish our empathy for strangers, and even manipulate fundamental aspects of our personalities, such as how neurotic we are.

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Research into these effects couldn’t come at a better time. The world is in the midst of a crisis of over-medication, with the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person – and the average American consuming $1,200 worth of prescription medications over the same period. And as the global population ages, our drug-lust is set to spiral even further out of control; in the UK, one in 10 people over the age of 65 already takes eight medications every week.

How are all these medications affecting our brains? And should there be warnings on packets?

The info is here.

The Ethical Practice of Psychotherapy: Clearly Within Our Reach

Jeff Barnett
Psychotherapy, 56(4), 431-440
http://dx.doi.org/10.1037/pst0000272

Abstract

This introductory article to the special section on ethics in psychotherapy highlights the challenges and ethical dilemmas psychotherapists regularly face throughout their careers, and the limits of the American Psychological Association Ethics Code in offering clear guidance for how specifically to respond to each of these situations. Reasons for the Ethics Code’s naturally occurring limitations are shared. The role of ethical decision-making, the use of multiple sources of guidance, and the role of consultation with colleagues to augment and support the psychotherapist’s professional judgment are illustrated. Representative ethics challenges in a range of areas of practice are described, with particular attention given to tele-mental health and social media, interprofessional practice and collaboration with medical professionals, and self-care and the promotion of wellness. Key recommendations are shared to promote ethical conduct and to resolve commonly occurring ethical dilemmas in each of these areas of psychotherapy practice. Each of the six articles that follow in this special section on ethics in psychotherapy are introduced, and their main points are summarized.

Here is an excerpt:

Yet, the ethical practice of psychotherapy is complex and multifaceted. This is true as well for psychotherapy research, the supervision of psychotherapy by trainees, and all other professional roles in which psychotherapists may serve. Psychotherapists engage in complex and challenging work in a wide range of practice settings, with a diverse range of clients/patients with highly individualized treatment needs, histories, and circumstances, using a plethora of possible treatment techniques and strategies. Each possible combination of these factors can yield a range of complexities, often presenting psychotherapists with challenges and situations that may not have been anticipated and that tax the psychotherapist’s ability to choose the correct or most appropriate course of action. In such circumstances, ethical dilemmas (situations in which no right or correct course of action is readily apparent and where multiple factors may influence or impact one’s decision on how to proceed) are common. Knowing how to respond to these challenges and dilemmas is of paramount importance for psychotherapists so that we may fulfill our overarching obligations to our clients and all others we serve in our professional roles.