Lawmakers Push Again for Info on Google Collecting Patient Data

Rob Copeland

Wall Street Journal
Originally published 3 March 20

A bipartisan trio of U.S. senators pushed again for answers on Google’s controversial “Project Nightingale,” saying the search giant evaded requests for details on its far-reaching data tie-up with health giant Ascension.

The senators, in a letter Monday to St. Louis-based Ascension, said they were put off by the lack of substantive disclosure around the effort.

Project Nightingale was revealed in November in a series of Wall Street Journal articles that described Google’s then-secret engagement to collect and crunch the personal health information of millions of patients across 21 states.

Sens. Richard Blumenthal (D., Conn.), Bill Cassidy (R., La.), and Elizabeth Warren (D., Mass.) subsequently wrote to the Alphabet Inc. GOOG +1.35% unit seeking basic information about the program, including the number of patients involved, the data shared and who at Google had access.

The head of Google Health, Dr. David Feinberg, responded with a letter in December that largely stuck to generalities, according to correspondence reviewed by the Journal.

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Ascension earlier this year fired an employee who had reached out to media, lawmakers and regulators with concerns about Project Nightingale, a person familiar with the matter said. 

The employee, who described himself as a whistleblower, was told by Ascension higher-ups that he had shared information about the initiative that was intended to be secret, the person said.

Nick Ragone, a spokesman for Ascension—one of the U.S.’s largest health-care systems with 2,600 hospitals, doctors’ offices and other facilities—declined to say why the employee in question was fired. 

The info is here.

Which Legal Approaches Help Limit Harms to Patients From Clinicians’ Conscience-Based Refusals?

R. Kogan, K. Kraschel, & C. Haupt
AMA J Ethics. 2020;22(3):E209-216.
doi: 10.1001/amajethics.2020.209.

Abstract

This article canvasses laws protecting clinicians’ conscience and focuses on dilemmas that occur when a clinician refuses to perform a procedure consistent with the standard of care. In particular, the article focuses on patients’ experience with a conscientiously objecting clinician at a secular institution, where patients are least likely to expect conscience-based care restrictions. After reviewing existing laws that protect clinicians’ conscience, the article discusses limited legal remedies available to patients.

Potential Sites of Conflict

Clinicians who object to providing care on the basis of “conscience” have never been more robustly protected than today by state legislatures and federal law. Although US law as well as professional ethics allows clinicians to deviate from professional norms and standards when their religious or moral beliefs conflict with a requested service,1 the scope of legal remedies for patients harmed by these objections has shrunk as federal and state law has effectively insulated objecting clinicians from liability. This article outlines laws protecting clinician conscience and identifies questions that arise when a clinician refuses to perform a procedure consistent with the medical profession’s standard of care. We focus on patients seeking care at secular institutions where patients are least likely to have notice that care they receive could be restricted based upon an individual clinician’s refusal. As a result, patients may unknowingly receive substandard care from objecting physicians and even be harmed by their refusals. However, the legal remedies available to patients adversely affected by refusals are limited. We first discuss federal and state law governing refusals based on clinician conscience and then examine the remedies available to patients who suffer harm as a result of a physician’s refusal.

The info is here.

On the Willingness to Report and the Consequences of Reporting Research Misconduct: The Role of Power Relations.

Horbach, S.P.J.M., et al.
Sci Eng Ethics (2020).
https://doi.org/10.1007/s11948-020-00202-8

Abstract

While attention to research integrity has been growing over the past decades, the processes of signalling and denouncing cases of research misconduct remain largely unstudied. In this article, we develop a theoretically and empirically informed understanding of the causes and consequences of reporting research misconduct in terms of power relations. We study the reporting process based on a multinational survey at eight European universities (N = 1126). Using qualitative data that witnesses of research misconduct or of questionable research practices provided, we aim to examine actors’ rationales for reporting and not reporting misconduct, how they report it and the perceived consequences of reporting. In particular we study how research seniority, the temporality of work appointments, and gender could impact the likelihood of cases being reported and of reporting leading to constructive organisational changes. Our findings suggest that these aspects of power relations play a role in the reporting of research misconduct. Our analysis contributes to a better understanding of research misconduct in an academic context. Specifically, we elucidate the processes that affect researchers’ ability and willingness to report research misconduct, and the likelihood of universities taking action. Based on our findings, we outline specific propositions that future research can test as well as provide recommendations for policy improvement.

From the Conclusion:

We also find that contested forms of misconduct (e.g. authorship, cherry picking of data and fabrication of data) are less likely to be reported than more clear-cut instances of misconduct (e.g. plagiarism, text recycling and falsification of data). The respondents mention that minor misbehaviour is not considered worth reporting, or express doubts about the effectiveness of reporting a case when the witnessed behaviour does not explicitly transgress norms, such as with many of the QRPs. Concern about reporting’s negative consequences, such as career opportunities or organisational reputations being harmed, is always taken into considerations.

Secondly, we have theorised the relationship between power differences and researchers’ willingness to report—in particular the role of seniority, work appointments and gender. We have derived a list of seven propositions that we believe warrant testing and refinement in future studies using a larger sample to help with further theory building about power differences and research misconduct.

The info is here.

The Tyranny of Time: How Long Does Effective Therapy Really Take?

Jonathan Shedler & Enrico Gnaulati
Psychotherapy Networker
Originally posted March/April 20

Here is an excerpt:

Like the Consumer Reports study, this study also found a dose–response relation between therapy sessions and improvement. In this case, the longer therapy continued, the more clients achieved clinically significant change. So just how much therapy did it take? It took 21 sessions, or about six months of weekly therapy, for 50 percent of clients to see clinically significant change. It took more than 40 sessions, almost a year of weekly therapy, for 75 percent to see clinically significant change.

Information from the surveys of clients and therapists turned out to be pretty spot on. Three independent data sources converge on similar time frames. Every client is different, and no one can predict how much therapy is enough for a specific person, but on average, clinically meaningful change begins around the six-month mark and grows from there. And while some people will get what they need with less therapy, others will need a good deal more.

This is consistent with what clinical theorists have been telling us for the better part of a century. It should come as no surprise. Nothing of deep and lasting value is cheap or easy, and changing oneself and the course of one’s life may be most valuable of all.

Consider what it takes to master any new and complex skill, say learning a language, playing a musical instrument, learning to ski, or becoming adept at carpentry. With six months of practice, you might attain beginner- or novice-level proficiency, maybe. If someone promised to make you an expert in six months, you’d suspect they were selling snake oil. Meaningful personal development takes time and effort. Why would psychotherapy be any different?

The info is here.

Better the Two Devils You Know, Than the One You Don’t: Predictability Influences Moral Judgment

A. Walker, M. Turpin, & others
PsyArXiv Preprints
Updated 6 April 20

Abstract

Across four studies (N =1,806 US residents), we demonstrate the role perceptions of predictability play in judgments of moral character, finding that less predictable agents were also judged as less moral. Participants judged agents performing an immoral action (e.g., assault) for an unintelligible reason as less predictable and less moral than agents performing the same immoral action for a well-understood immoral reason (Studies 1-3). Additionally, agents performing an action in an unusual way were judged as less predictable and less moral than those performing the same action in a common manner (Study 4). These results challenge monist theories of moral psychology, which reduce morality to a single dimension (e.g., harm) and pluralist accounts failing to consider the role predictability plays in moral judgments. We propose that predictability influences judgments of moral character for its ultimate role in facilitating cooperation and discuss how these findings may be accommodated by theories of morality-as-cooperation.

From the General Discussion

Supporting the idea that judgments of predictability guide judgments of moral character, we show that people judge agents they perceive as less predictable to be less moral. Those signalling unpredictability with their actions, either by acting without an intelligible motive(Studies 1-3)or by performing an immoral act in an unusual manner(Study 4), are consistently viewed as possessing an especially poor moral character.

Despite its importance for cooperation, and therefore moral judgments (Curry, 2016; Curry et al., 2019; Greene, 2013; Haidt, 2012; Rai& Fiske, 2011; Tomasello & Vaish, 2013), dominant theories of moral psychology have not explicitly considered the role predictability plays in judgments of moral character. Here we presented novel scenarios for which many popular theoretical frameworks fail to accurately capture participants’ moral impressions.

The research is here.

Moralizing biology: The appeal and limits of the new compassionate view of nature

Maurizio Meloni
History of the Human Sciences, 
July 2013 vol. 26 no. 3 82-106

Abstract

In recent years, a proliferation of books about empathy, cooperation, and prosocial behaviours (Brooks, 2011a) have significantly influenced the discourse of the life sciences and reversed consolidated views of nature as a place only for competition and aggression. In this article I describe the recent contribution of three disciplines: moral psychology (Jonathan Haidt), primatology (Frans de Waal) and the neuroscience of morality, to the present transformation of biology and evolution into direct sources of moral phenomena, a process here named the ‘moralization of biology’. I conclude by addressing the ambivalent status of this constellation of authors, for whom today ‘morality comes naturally’: I explore both the attractiveness of their message, and the problematic epistemological assumptions of their research programs in the light of new discoveries in developmental and molecular biology.

Here is an excerpt:

However, why should the dichotomous framework, which sets up an opposition between biology as a solid bedrock and cultural/psychological processes, persist in the light of the new epistemology of the gene? Philosophers of biology have often attributed such persistence to the fact that scholars who usually ‘know better’ occasionally lapse into epistemologically outmoded views (Griffiths, 1999; Linquist et al., 2011), possibly confused by notions like innateness that permit unjustified inferences too easily (Griffiths, 2002).  While this is certainly a plausible explanation it does not rule out a second one, namely that this outmoded epistemology still pays political dividends today, making it inconvenient to let it go. I refer to the returns that this stratigraphic view of biology still yields today in terms of political hope and optimism.

The paper is here.

Virus lays bare the frailty of the social contract

Editorial Board
Financial Times
Originally published 3 April 20

If there is a silver lining to the Covid-19 pandemic, it is that it has injected a sense of togetherness into polarised societies. But the virus, and the economic lockdowns needed to combat it, also shine a glaring light on existing inequalities — and even create new ones. Beyond defeating the disease, the great test all countries will soon face is whether current feelings of common purpose will shape society after the crisis. As western leaders learnt in the Great Depression, and after the second world war, to demand collective sacrifice you must offer a social contract that benefits everyone.

Today’s crisis is laying bare how far many rich societies fall short of this ideal. Much as the struggle to contain the pandemic has exposed the unpreparedness of health systems, so the brittleness of many countries’ economies has been exposed, as governments scramble to stave off mass bankruptcies and cope with mass unemployment. Despite inspirational calls for national mobilisation, we are not really all in this together.

The economic lockdowns are imposing the greatest cost on those already worst off. Overnight millions of jobs and livelihoods have been lost in hospitality, leisure and related sectors, while better paid knowledge workers often face only the nuisance of working from home. Worse, those in low-wage jobs who can still work are often risking their lives — as carers and healthcare support workers, but also as shelf stackers, delivery drivers and cleaners.

The info is here.

Banned Devices; Proposal To Ban Electrical Stimulation Devices Used To Treat Self-Injurious or Aggressive Behavior

FDA Press Release
Posted March 5, 2020

Here is an excerpt:

After careful consideration, the U.S. Food and Drug Administration today published a final rule to ban electrical stimulation devices (ESDs) used for self-injurious or aggressive behavior because they present an unreasonable and substantial risk of illness or injury that cannot be corrected or eliminated through new or updated device labeling.

“Since ESDs were first marketed more than 20 years ago, we have gained a better understanding of the danger these devices present to public health,” said William Maisel, M.D., M.P.H., director of the Office of Product Evaluation and Quality in the FDA’s Center for Devices and Radiological Health. “Through advancements in medical science, there are now more treatment options available to reduce or stop self-injurious or aggressive behavior, thus avoiding the substantial risk ESDs present.”

ESDs administer electrical shocks through electrodes attached to the skin of individuals to immediately interrupt self-injurious or aggressive behavior or attempt to condition the individuals to stop engaging in such behavior. Evidence indicates a number of significant psychological and physical risks are associated with the use of these devices, including worsening of underlying symptoms, depression, anxiety, posttraumatic stress disorder, pain, burns and tissue damage. In addition, many people who are exposed to these devices have intellectual or developmental disabilities that make it difficult to communicate their pain. Evidence of the device’s effectiveness is weak and evidence supporting the benefit-risk profiles of alternatives is strong. As the risks presented by ESDs meet the agency’s definition of unreasonable and substantial and cannot be corrected or eliminated through new or updated labeling, banning the product is necessary to protect public health.

The act of banning a device is rare and the circumstances under which the agency can take this action is stringent, but the FDA has the authority to take this action when necessary to protect the health of the public. The FDA has only banned two other medical devices since gaining the authority to do so.

This final rule issued today follows a 2016 proposed rule to ban ESDs from the marketplace and takes effect 30 days after publication in the Federal Register. The FDA understands that a gradual transition period may be needed for a subgroup of individuals currently exposed to these devices, to allow time for them to transition to another treatment, so the agency is establishing two compliance dates. For devices in use on specific individuals as of the date of publication and subject to a physician-directed transition plan, compliance is required 180 days after publication of the final rule in the Federal Register. For all other devices, compliance is required 30 days after publication of the final rule in the Federal Register.

The FDA received more than 1,500 comments on the proposed rule, as well as approximately 300 comments submitted to the April 2014 FDA advisory panel meetingExternal Link Disclaimerdocket, which the FDA has associated with this rulemaking action. Comments were received from a variety of stakeholders, including parents of individuals with intellectual and developmental disabilities, state agencies and their sister public-private organizations, the affected manufacturer and residential facility, some of the facility’s employees, and parents of individual residents. State and federal legislators also expressed interest, as did state and national advocacy groups. The overwhelming majority of comments supported this ban.

The proposed rule is here.

How a Ship’s Coronavirus Outbreak Became a Moral Crisis for the Military

Helene Cooper,
Thomas Gibbons-Neff, & Eric Schmitt
The New York Times
Originally posted 6 April 20

Here is an excerpt:

In the close-knit world of the American military, the crisis aboard the Roosevelt — known widely as the “T.R.”— generated widespread criticism from men and women who are usually careful to steer clear of publicly rebuking their peers.

Mr. Modly’s decision to remove Captain Crozier without first conducting an investigation went contrary to the wishes of both the Navy’s top admiral, Michael M. Gilday, the chief of naval operations, and the military’s top officer, Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff.

“I am appalled at the content of his address to the crew,” retired Adm. Mike Mullen, the chairman of the Joint Chiefs of Staff under Presidents George W. Bush and Barack Obama, said in a telephone interview, referring to Mr. Modly.

Mr. Modly, Admiral Mullen said, “has become a vehicle for the president. He basically has completely undermined, throughout the T.R. situation, the uniformed leadership of the Navy and the military leadership in general.”

Mr. Modly, Admiral Mullen said, “has become a vehicle for the president. He basically has completely undermined, throughout the T.R. situation, the uniformed leadership of the Navy and the military leadership in general.”

“At its core, this is about an aircraft carrier skipper who sees an imminent threat and is forced to make a decision that risks his career in the act of what he believes to be the safety of the near 5,000 members of his crew,” said Sean O’Keefe, a former Navy secretary under President George Bush. “That is more than enough to justify the Navy leadership rendering the benefit of the doubt to the deployed commander.”

The info is here.