Ethical concerns with online direct-to-consumer pharmaceutical companies

Curtis H, Milner J
Journal of Medical Ethics 
2020;46:168-171.

Abstract

In recent years, online direct-to-consumer pharmaceutical companies have been created as an alternative method for individuals to get prescription medications. While these companies have noble aims to provide easier, more cost-effective access to medication, the fact that these companies both issue prescriptions (via entirely online medical reviews that can have no direct contact between physician and patient) as well as distribute and ship medications creates multiple ethical concerns. This paper aims to explore two in particular. First, this model creates conflicts of interest for the physicians hired by these companies to write prescriptions. Second, the lack of direct contact from physicians may be harmful to prospective patients. After analysing these issues, this paper argues that there ought to be further consideration for regulation and oversight for these companies.

The info is here.

Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Melissa Bailey
Kaiser Health News
Originally published 4 Feb 20

Here are two excerpts:

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

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“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

The info is here.

How Common Mental Shortcuts Can Cause Major Physician Errors

Anupam B. Jena and Andrew R. Olenski
The New York Times
Originally posted 20 Feb 20

Here is an excerpt:

In health care, such unconscious biases can lead to disparate treatment of patients and can affect whether similar patients live or die.

Sometimes these cognitive biases are simple overreactions to recent events, what psychologists term availability bias. One study found that when patients experienced an unlikely adverse side effect of a drug, their doctor was less likely to order that same drug for the next patient whose condition might call for it, even though the efficacy and appropriateness of the drug had not changed.

A similar study found that when mothers giving birth experienced an adverse event, their obstetrician was more likely to switch delivery modes for the next patient (C-section vs. vaginal delivery), regardless of the appropriateness for that next patient. This cognitive bias resulted in both higher spending and worse outcomes.

Doctor biases don’t affect treatment decisions alone; they can shape the profession as a whole. A recent study analyzed gender bias in surgeon referrals and found that when the patient of a female surgeon dies, the physician who made the referral to that surgeon sends fewer patients to all female surgeons in the future. The study found no such decline in referrals for male surgeons after a patient death.

This list of biases is far from exhaustive, and though they may be disconcerting, uncovering new systematic mistakes is critical for improving clinical practice.

The info is here.

Stressed Out at the Office? Therapy Can Come to You

Rachel Feintzeig
The Wall Street Journal
Originally published 31 Jan 20

Here is an excerpt:

In the past, discussion of mental-health issues at the office was uncommon. Workers were largely expected to leave their personal struggles at home. Crying was confined to the bathroom stall.

Today, that’s changing. One reason is a broadening of the popular understanding of “mental health” to encompass anxiety, stress and other widespread issues.

It’s also a reflection of a changing workplace. Younger workers are more comfortable talking about their struggles and expect their employers to take emotional distress seriously, says Jeffrey Pfeffer, a professor of organizational behavior at the Stanford Graduate School of Business.

Senior leaders are responding, rolling out mental-health services and sometimes speaking about their own experiences. Lloyds Banking Group Plc chief executive António Horta-Osório has said publicly in recent years that the pressure he felt around the bank’s financial situation in 2011 dominated his thoughts, leaving him unable to sleep and exhausted. He took eight weeks off from the company to recover, working with a psychiatrist. The psychiatrist later helped him devise a mental-health program for Lloyds employees.

Brynn Brichet, a lead product manager at Cerner Corp., a maker of electronic medical-records systems, said she sometimes returns from her counseling appointments with an on-site therapist red-faced from crying. (The therapist sits a few floors down.) If colleagues ask, she tells them that she just got out of an intense therapy session. Some are taken aback when she mentions her therapy, she said. But she thinks it’s important to be open.

“We all are terrified. We all are struggling,” she said. “If we don’t talk about it, it can run our lives.”

The info is here.

It Pays to Be Yourself

Francesca Gino
hbr.org
Originally posted 13 Feb 20

Whether it’s trying to land a new job or a new deal or client, we often focus on making a good initial impression on people, especially when they don’t know us well or the stakes are high. One strategy people often use is to cater to the interests, preferences, and expectations of the person they want to impress. Most people, it seems, believe this is a more promising strategy than being themselves and use it in high-stakes interpersonal first meetings. But research I conducted with Ovul Sezer of the University of Carolina at Chapel Hill and Laura Huang of Harvard Business School found those beliefs are wrong.

Our research confirmed that catering to others’ interests and expectations is quite common. When we asked over 450 employed adults to imagine they were about to have an important professional interaction — such as interviewing for their dream job, conducting a valuable negotiation for their company, pitching an entrepreneurial idea to potential investors, or making a presentation to a client — 66% of them indicated they would use catering techniques, rather than simply being themselves; 71% reported believing that catering would be the most effective approach in the situation.

But another study we conducted found that catering was much less effective than being yourself. We asked 166 entrepreneurs to participate in a “fast-pitch” competition held at a private university in the northeastern United States. Each entrepreneur presented his or her venture idea to a panel of three judges: experienced, active members of angel investment groups. The ideas pitched were all in the early stages; none had received any external financing. At the end of the event, the judges collectively deliberated to choose 10 semifinalists who would be invited to participate in the final round. After entrepreneurs made their pitches, we had them answer a few questions about their presentations. We found that when they were genuine in their pitches, they were more than three times as likely to be chosen as semifinalists than when they tried to cater to the judges.

The info is here.

The lesser of two evils: Explaining a bad choice by revealing the choice set

Andras Molnar & Shereen J. Chaudhry
PsyArXiv
Last edited 4 Feb 20

Abstract

Making the right choice does not always lead to a good outcome—sometimes there are only bad outcomes to choose from. Situations like this are likely to lead others to misunderstand the decision maker’s intentions. However, simply revealing the choice set could set the record straight. Are decision-makers intrinsically driven to fix this misjudgment? If so, why, and what is the effect on the audience? Previous studies could not examine this desire to be understood because the research designs used did not isolate the decision to reveal information from the original choice. In two experiments (N=448 pairs), we address this gap in the literature and show that people are willing to pay ex post to reveal their choice set to the person who was negatively affected by their decision (the recipient), even after a one-shot anonymous interaction with no reputational consequences, and in some cases even when doing so reveals their selfish intentions. We find that this revealing behavior is effective at improving recipients’ rating of their outcome when it signals generous intentions, but not when it signals selfish intentions. It follows that the choice to reveal is driven by concern for the thoughts and feelings of strangers, but only when revealing signals generous intentions; those who reveal a choice that appears selfish report doing so out of a desire to be and/or appear honest. Individual differences in the drive to reveal cannot be explained by selection effects or mistakes in predicting the observer’s reaction. Thus, we find that people are intrinsically (i.e., even in one-shot anonymous settings) driven to correct a misunderstanding of their intentions, but they may do so for a variety of reasons, not all of which are self-enhancing. And though some people leave a misunderstanding in place when it is self-enhancing to do so, almost no one is willing to create a misunderstanding (by hiding the other option), even when it could conceal selfish behavior.

The research is here.

The Dunning-Kruger effect, or why the ignorant think they’re experts

Alexandru Micu
zmescience.com
Originally posted 13 Feb 20

Here is an excerpt:

It’s not specific only to technical skills but plagues all walks of human existence equally. One study found that 80% of drivers rate themselves as above average, which is literally impossible because that’s not how averages work. We tend to gauge our own relative popularity the same way.

It isn’t limited to people with low or nonexistent skills in a certain matter, either — it works on pretty much all of us. In their first study, Dunning and Kruger also found that students who scored in the top quartile (25%) routinely underestimated their own competence.

A fuller definition of the Dunning-Kruger effect would be that it represents a bias in estimating our own ability that stems from our limited perspective. When we have a poor or nonexistent grasp on a topic, we literally know too little of it to understand how little we know. Those who do possess the knowledge or skills, however, have a much better idea of where they sit. But they also think that if a task is clear and simple to them, it must be so for everyone else as well.

A person in the first group and one in the second group are equally liable to use their own experience and background as the baseline and kinda just take it for granted that everyone is near that baseline. They both partake in the “illusion of confidence” — for one, that confidence is in themselves, for the other, in everyone else.

The info is here.

Folk standards of sound judgment: Rationality vs. Reasonableness

Igor Grossman and others
PsyArXiv Preprints
Last edited on 10 Jan 20

Abstract

Normative theories of judgment either focus on rationality – decontextualized preference maximization, or reasonableness – the pragmatic balance of preferences and socially-conscious norms. Despite centuries of work on such concepts, a critical question appears overlooked: How do people’s intuitions and behavior align with the concepts of rationality from game theory and reasonableness from legal scholarship? We show that laypeople view rationality as abstract and preference-maximizing, simultaneously viewing reasonableness as social-context-sensitive and socially-conscious, as evidenced in spontaneous descriptions, social perceptions, and linguistic analyses of the terms in cultural products (news, soap operas, legal opinions, and Google books). Further, experiments among North Americans and Pakistani bankers, street merchants, and samples engaging in exchange (vs. market-) economy show that rationality and reasonableness lead people to different conclusions about what constitutes good judgment in Dictator Games, Commons Dilemma and Prisoner’s Dilemma: Lay rationality is reductionist and instrumental, whereas reasonableness integrates preferences with particulars and moral concerns.

The research is here.

The Dark Side of Morality: Group Polarization and Moral Epistemology

Marcus Arvan

PsyArXiv

Originally published on 12 Dec 19

Abstract

This paper shows that philosophers and laypeople commonly conceptualize moral truths as discoverable through intuition, argument, or some other process. It then argues that three empirically-supported theories of group polarization suggest that this Discovery Model of morality likely plays a substantial role in causing polarization—a phenomenon known to produce a wide variety of disturbing social effects, including increasing prejudice, selfishness, divisiveness, mistrust, and violence. This paper then uses the same three empirical theories to argue that an alternative Negotiation Model of morality—according to which moral truths are instead created by negotiation—promises to not only mitigate polarization but perhaps even foster its opposite: a progressive willingness to “work across the aisle to settle contentious moral issues cooperatively. Finally, I outline avenues for further empirical and philosophical research.

Conclusion

Laypeople  and  philosophers  tend  to  treat  moral  truths  as discoverable  through  intuition, argument,  or  other cognitive  or  affective  process. However,  we  have  seen that  there  are strong theoretical   reasons—based   on   three   empirically-supported   theories   of   group polarization—to believe this Discovery Model of morality is a likely cause of polarization: a social-psychological phenomenon known to have a wide variety of disturbing social effects. We then saw that there are complementary theoretical reasons to believe that an alternative, Negotiation  Model of  morality  might  not  only  mitigate  polarization  but  actually  foster  its opposite: an increasing willingness for to work together to arrive at compromises on moral controversies. While   this   paper   does   not prove   the   existence   of   the   hypothesized relationships   between   the   Discovery   Model,  Negotiation   Model,   and   polarization,   it demonstrates that there are ample theoretical reasons to believe that such relationships are likely and worthy of further empirical and philosophical research.