Business gets ready to trip

Jeffrey O'Brien
Forbes. com
Originally posted 17 Feb 20

Here is an excerpt:

The need for a change in approach is clear. “Mental illness” is an absurdly large grab bag of disorders, but taken as a whole, it exacts an astronomical toll on society. The National Institute of Mental Health says nearly one in five U.S. adults lives with some form of it. According to the World Health Organization, 300 million people worldwide have an anxiety disorder. And there’s a death by suicide every 40 seconds—that includes 20 veterans a day, according to the U.S. Department of Veterans Affairs. Almost 21 million Americans have at least one addiction, per the U.S. Surgeon General, and things are only getting worse. The Lancet Commission—a group of experts in psychiatry, public health, neuroscience, etc.—projects that the cost of mental disorders, currently on the rise in every country, will reach $16 trillion by 2030, including lost productivity. The current standard of care clearly benefits some. Antidepressant medication sales in 2017 surpassed $14 billion. But SSRI drugs—antidepressants that boost the level of serotonin in the brain—can take months to take hold; the first prescription is effective only about 30% of the time. Up to 15% of benzodiazepine users become addicted, and adults on antidepressants are 2.5 times as likely to attempt suicide.

Meanwhile, in various clinical trials, psychedelics are demonstrating both safety and efficacy across the terrain. Scientific papers have been popping up like, well, mushrooms after a good soaking, producing data to blow away conventional methods. Psilocybin, the psychoactive ingredient in magic mushrooms, has been shown to cause a rapid and sustained reduction in anxiety and depression in a group of patients with life-threatening cancer. When paired with counseling, it has improved the ability of some patients suffering from treatment-resistant depression to recognize and process emotion on people’s faces. That correlates to reducing anhedonia, or the inability to feel pleasure. The other psychedelic agent most commonly being studied, MDMA, commonly called ecstasy or molly, has in some scientific studies proved highly effective at treating patients with persistent PTSD. In one Phase II trial of 107 patients who’d had PTSD for an average of over 17 years, 56% no longer showed signs of the affliction after one session of MDMA-assisted therapy. Psychedelics are helping to break addictions, as well. A combination of psilocybin and cognitive therapy enabled 80% of one study’s participants to kick cigarettes for at least six months. Compare that with the 35% for the most effective available smoking-cessation drug, varenicline.

The info is here.

Artificial Intelligence in Health Care

M. Matheny, D. Whicher, & S. Israni
JAMA. 2020;323(6):509-510.
doi:10.1001/jama.2019.21579

The promise of artificial intelligence (AI) in health care offers substantial opportunities to improve patient and clinical team outcomes, reduce costs, and influence population health. Current data generation greatly exceeds human cognitive capacity to effectively manage information, and AI is likely to have an important and complementary role to human cognition to support delivery of personalized health care.  For example, recent innovations in AI have shown high levels of accuracy in imaging and signal detection tasks and are considered among the most mature tools in this domain.

However, there are challenges in realizing the potential for AI in health care. Disconnects between reality and expectations have led to prior precipitous declines in use of the technology, termed AI winters, and another such event is possible, especially in health care.  Today, AI has outsized market expectations and technology sector investments. Current challenges include using biased data for AI model development, applying AI outside of populations represented in the training and validation data sets, disregarding the effects of possible unintended consequences on care or the patient-clinician relationship, and limited data about actual effects on patient outcomes and cost of care.

AI in Healthcare: The Hope, The Hype, The Promise, The Peril, a publication by the National Academy of Medicine (NAM), synthesizes current knowledge and offers a reference document for the responsible development, implementation, and maintenance of AI in the clinical enterprise.  The publication outlines current and near-term AI solutions; highlights the challenges, limitations, and best practices for AI development, adoption, and maintenance; presents an overview of the legal and regulatory landscape for health care AI; urges the prioritization of equity, inclusion, and a human rights lens for this work; and outlines considerations for moving forward. This Viewpoint shares highlights from the NAM publication.

The info is here.

Expertise in Child Abuse?

Dr. Woods, from a YouTube video

Mike Hixenbaugh & Taylor Mirfendereski
NBCnews.com
Originally posted 14 Feb 20

Here is an excerpt:

Contrary to Woods’ testimony, there are more than 375 child abuse pediatricians certified by the American Board of Pediatrics in the U.S., all of whom have either completed an extensive fellowship program — first offered, not three, but nearly 15 years ago, while Woods was still in medical school — or spent years examining cases of suspected abuse prior to the creation of the medical subspecialty in 2009. The doctors are trained to differentiate accidental from inflicted injuries, which child abuse pediatricians say makes them better qualified than other doctors to determine whether a child has been abused. At least three physicians have met those qualifications and are practicing as board-certified child abuse pediatricians in the state of Washington.

Woods is not one of them.

Despite her lack of fellowship training, state child welfare and law enforcement officials in Washington have granted Woods remarkable influence over their decisions about whether to remove children from parents or pursue criminal charges, NBC News and KING 5 found. In four cases reviewed by reporters, child welfare workers took children from parents based on Woods’ reports — including some in which Woods misstated key facts, according to a review of records — despite contradictory opinions from other medical experts who said they saw no evidence of abuse.

In one instance, a pediatrician, Dr. Niran Al-Agba, insisted that a 2-year-old child’s bruise matched her parents’ description of an accidental fall onto a heating grate in their home. But Child Protective Services workers, who’d gotten a call from the child’s day care after someone noticed the bruise, asked Woods to look at photos of the injury.

Woods reported that the mark was most likely the result of abuse, even though she’d never seen the child in person or talked to the parents. The agency sided with her. To justify that decision, the Child Protective Services worker described Woods as “a physician with extensive training and experience in regard to child abuse and neglect,” according to a written report reviewed by reporters.

The info is here.

The Polarization of Reality

A. Alesina, A. Miano, and S. Stantcheva
American Economic Review Papers and Proceedings

Evidence is growing that Americans are polarized not only in their views on policy issues and attitudes towards government and society, but also in their perceptions of the same, factual reality.

In this paper we conceptualize how to think about the polarization of reality and review recent papers that show that Republican and Democrats as well as Trump and non-Trump voters since 2016) view the same reality through a different lens. Perhaps as a result, they hold different views about policies and what should be done to address different economic and social issues.

The direction of causality is unclear: On the one hand, individuals could select into political affiliation based on their perceptions of reality. On the other hand, political affiliation affects the information one receives, the groups one interacts with, and the media one is exposed to, which in turn can shape perceptions of reality.

Regardless of the direction of causality though, this is not about having different attitudes about economic or social phenomena or policies that could justifiably be viewed differently from different angles.

What is striking is rather to have different perceptions of realities that can be factually checked.

We highlight evidence about differences in perceptions across the political spectrum on social mobility, inequality, immigration, and public policies.


We also show that providing information leads to different reassessments of reality and different responses along the policy support margin, depending on one’s political leanings.

The paper can be downloaded here.

Three Unresolved Issues in Human Morality

Jerome Kagan
Perspectives on Psychological Science
First Published March 28, 2018

Abstract

This article discusses three major, but related, controversies surrounding the idea of morality. Is the complete pattern of features defining human morality unique to this species? How context dependent are moral beliefs and the emotions that often follow a violation of a moral standard? What developmental sequence establishes a moral code? This essay suggests that human morality rests on a combination of cognitive and emotional processes that are missing from the repertoires of other species. Second, the moral evaluation of every behavior, whether by self or others, depends on the agent, the action, the target of the behavior, and the context. The ontogeny of morality, which begins with processes that apes possess but adds language, inference, shame, and guilt, implies that humans are capable of experiencing blends of thoughts and feelings for which no semantic term exists. As a result, conclusions about a person’s moral emotions based only on questionnaires or interviews are limited to this evidence.

From the Summary

The human moral sense appears to contain some features not found in any other animal. The judgment of a behavior as moral or immoral, by self or community, depends on the agent, the action, and the setting. The development of a moral code involves changes in both cognitive and affective processes that are the result of maturation and experience. The ideas in this essay have pragmatic implications for psychological research. If most humans want others to regard them as moral agents, and, therefore, good persons, their answers to questionnaires or to interviewers as well as behaviors in laboratories will tend to conform to their understanding of what the examiner regards as the society’s values. That is why investigators should try to gather evidence on the behaviors that their participants exhibit in their usual settings.

The article is here.

The Perils of “Survivorship Bias”

Katy Milkman
Scientific American
Originally posted 11 Feb 20

Here is an excerpt:

My colleagues and I, we’ve been spending a lot of time looking at medical decision-making. Say you walk into an emergency room, and you might or might not be having a heart attack. If I test you, I learn whether I’m making a good decision or not. But if I say, “It’s unlikely, so I’ll just send her home,” it’s almost the opposite of survivorship bias. I never get to learn if I made a good decision. And this is supercommon, not just in medicine but in every profession.

Similarly, there was a work done that showed that people who had car accidents were also more likely to have cancer. It was kind of a puzzle until you think, “Wait, who do we measure cancer in?” We don’t measure cancer in everybody. We measure cancer in people who have been tested. And who do we test? We test people who are in hospitals. So someone goes to the hospital for a car accident, and then I do an MRI and find a tumor. And now that leads to car accidents appearing to elevate the level of tumors. So anything that gets you into hospitals raises your “cancer rate,” but that’s not your real cancer rate.

That’s one of my favorite examples, because it really illustrates how even with something like cancer, we’re not actually measuring it without selection bias, because we only measure it in a subset of the population.

How can people avoid falling prey to these kinds of biases?

Look at your life and where you get feedback and ask, “Is that feedback selected, or am I getting unvarnished feedback?”

Whatever the claim—it could be “I’m good at blank” or “Wow, we have a high hit rate” or any sort of assessment—then you think about where the data comes from. Maybe it’s your past successes. And this is the key: Think about what the process that generated the data is. What are all the other things that could have happened that might have led me to not measure it? In other words, if I say, “I’m great at interviewing,” you say, “Okay. Well, what data are you basing that on?” “Well, my hires are great.” You can counter with, “Have you considered the people who you have not hired?”

The info is here.

The dangerous veneer of ‘science’

Regini Rini
Times Literary Supplement
Originally posted Feb 20

"Race science” seems to be the hideous new trend of 2020. Last month, an article in the journal Philosophical Psychology calling for greater investigation of purported genetic bases for racial IQ differences became the focus of intense academic controversy. Then came a new book, Human Diversity, from Charles Murray, prompting the New York Times columnist Jamelle Bouie to tweet: “i guess we’re gonna spend february arguing with phrenologists”. And then just this week, a twenty-seven-year-old consultant to the British government quickly resigned following media reports of his apparent musings on eugenics.

What’s going on? Why are we suddenly talking about this nonsense again? Donald Trump, and the winks he tosses to torch-wielding “blood and soil” marchers, may have something to do with it. Clearly there is a market for white coats who cater to white hoods. But the “race science” racket is growing, and we needn’t assume that all its practitioners have such transparently bigoted motives. Rather, I suspect that some are in it for the iconoclastic thrill of prodding at bien pensant pieties from behind the intellectual shield of capital-S Science.

There has always been a certain sort of mind that delights in saying whatever is verboten, from the Marquis de Sade to Christopher Hitchens. The writer George Packer worries that, in the high-stakes moral atmosphere of the Trump era, we no longer have cultural space for such fearless exploration of opinion. But I think this gets things exactly backwards. Trumpism is partly a result of the fact that it is now much easier to acquire an audience for heterodoxy. You don’t have to be a gifted essayist; you need only a Twitter account and lack of moral inhibition. Thoughtful iconoclasts aren’t silenced, they’re merely lost amid the din of so many icons being artlessly shattered.

The info is here.

The Role of Passing Time in Decision-Making

N. Evans, G. Hawkins, & S. Brown
PsyArXiv
Last edited 1 April 19

Abstract

Theories of perceptual decision-making have been dominated by the idea that evidence accumulates in favor of different alternatives until some fixed threshold amount is reached, which triggers a decision. Recent theories have suggested that these thresholds may not be fixed during each decision, but change as time passes. These collapsing thresholds can improve performance in particular decision environments, but reviews of data from typical decision-making paradigms have failed to support collapsing thresholds. We designed three experiments to test collapsing threshold assumptions in decision environments specifically tailored to make them optimal. An emphasis on decision speed encouraged the adoption of collapsing thresholds – most strongly through the use of response deadlines, but also through instruction to a lesser extent – but setting an explicit goal of reward rate optimality through both instructions and task design did not. Our results provide a new explanation for previous findings regarding decision-making differences between humans and non-human primates.

The research is here.

Humility and self-doubt are hallmarks of a good therapist

Helene Nissen-Lie
aeon.co
Originally posted 5 Feb 20

Here is an excerpt:

However, therapist humility on its own is not sufficient for therapy to be effective. In our latest study, we assessed how much therapists treat themselves in a kind and forgiving manner in their personal lives (ie, report more ‘self-affiliation’) and their perceptions of themselves professionally. We anticipated that therapists’ level of personal self-affiliation would enhance the effect that professional self-doubt has on therapeutic change. Our hypothesis was supported: therapists who reported more self-doubt in their work alleviated client distress more if they also reported being kind to themselves outside of work (in contrast, therapists who scored low on self-doubt and high on self-affiliation contributed to the least change).

We interpreted this finding to imply that a benign self-critical stance in a therapist is beneficial, but that self-care and forgiveness without reflective self-criticism is not. The combination of self-affiliation and professional self-doubt seems to pave the way for an open, self-reflective attitude that allows psychotherapists to respect the complexity of their work, and, when needed, to correct the therapeutic course to help clients more effectively.

What does all this mean? At a time when people tend to think that their value is based on how confident they are and that they must ‘sell themselves’ in every situation, the finding that therapist humility is an underrated virtue and a paradoxical ingredient of expertise might be a relief.

The info is here.