Physician at Epicenter of COVID-19 Crisis Lost to Suicide

Dr. Lorna Breem

Marcia Frellick
MedScape.com
Originally published 28 April 20

Grief-laden posts are coursing through social media following the suicide on Sunday of emergency department physician Lorna M. Breen, MD, who had been immersed in treating COVID-19 patients at the epicenter of the disease in New York City.

Breen, 49, was the medical director of the ED at NewYork-Presbyterian Allen Hospital in Manhattan.

According to a New York Times report, her father, Dr Philip C. Breen, of Charlottesville, Virginia, said his daughter did not have a history of mental illness but had described wrenching scenes, including that patients "were dying before they could even be taken out of ambulances."

The report said Lorna Breen had also contracted the virus but had returned to work after recovering for about 10 days.

Her father told the Times that when he last spoke with her, she seemed "detached" and he knew something was wrong.

"The hospital sent her home again, before her family intervened to bring her to Charlottesville," the elder Breen told the newspaper.

The article indicated that Charlottesville police officers on Sunday responded to a call and Breen was taken to University of Virginia Hospital, where she died from self-inflicted injuries.

The info is here.

Characteristics of Faculty Accused of Academic Sexual Misconduct in the Biomedical and Health Sciences

Espinoza M, Hsiehchen D.
JAMA. 2020;323(15):1503–1505.
doi:10.1001/jama.2020.1810

Abstract

Despite protections mandated in educational environments, unwanted sexual behaviors have been reported in medical training. Policies to combat such behaviors need to be based on better understanding of the perpetrators. We characterized faculty accused of sexual misconduct resulting in institutional or legal actions that proved or supported guilt at US higher education institutions in the biomedical and health sciences.

Discussion

Of biomedical and health sciences faculty accused of sexual misconduct resulting in institutional or legal action, a majority were full professors, chairs or directors, or deans. Sexual misconduct was rarely an isolated event. Accused faculty frequently resigned or remained in academics, and few were sanctioned by governing boards.

Limitations include that only data on accused faculty who received media attention or were involved in legal proceedings were captured. In addition, the duration of behaviors, the exact number of targets, and the outcome data could not be identified for all accused faculty. Thus, this study cannot determine the prevalence of faculty who commit sexual misconduct, and the characteristics may not be generalizable across institutions.

The lack of transparency in investigations suggests that misconduct behaviors may not have been wholly captured by the public documents. Efforts to eliminate nondisclosure agreements are needed to enhance transparency. Further work is needed on mechanisms to prevent sexual misconduct at teaching institutions.

The info is here.

Athletes often don’t know what they’re talking about (Apparently, neither do Presidents)

Cathal Kelly
The Globe and Mail
Originally posted 20 April 20

Here is an excerpt:

This is what happens when we depend on celebrities to amplify good advice. The ones who have bad advice will feel similarly empowered. You can see where this particular case slid off the rails.

Djokovic has spent years trying to curate an identity as a sports brand. Early on, he tried the Tiger Beat route, a la Rafael Nadal. When that didn’t work, he tried haughty and detached, a la Roger Federer. Same result.

Some time around 2010, Djokovic decided to go Full Weirdo. He gave up gluten, got into cosmology and decided to present himself as a sort of seeker of universal truths. He even let everyone know that he’d been visiting a Buddhist temple during Wimbledon because … well, who knows what enlightenment and winning at tennis have to do with each other?

Nobody really got his new act, but this switch happened to coincide with Djokovic’s rise to the top. So he stuck with it.

This went hand in hand with an irrepressibly chirpy public persona, one so calculatedly ingratiating that it often had the opposite effect.

It wasn’t a terrible strategy. Highly successful sporting oddbods usually become cult stars. If they hang on long enough, they find general acceptance.

But it didn’t turn out for Djokovic. Even now that he is arguably the greatest men’s player of all time, he still can’t manage the trick. There’s just something about the guy that seems a bit not-of-this-world.

The info is here.

What needs to happen before your boss can make you return to work

Mark Kaufman
www.mashable.com
Originally posted 24 April 20

Here is an excerpt:

But, there is a way for tens of millions of Americans to return to workplaces while significantly limiting how many people infect one another. It will require extraordinary efforts on the part of both employers and governments. This will feel weird, at first: Imagine regularly having your temperature taken at work, routinely getting tested for an infection or immunity, mandatory handwashing breaks, and perhaps even wearing a mask.

Yet, these are exceptional times. So restarting the economy and returning to workplace normalcy will require unparalleled efforts.

"This is truly unprecedented," said Christopher Hayes, a labor historian at the Rutgers School of Management and Labor Relations.

"This is like the 1918 flu and the Great Depression at the same time," Hayes said.

Yet unlike previous recessions and depressions over the last 100 years, most recently the Great Recession of 2008-2009, American workers must now ask themselves an unsettling question: "People now have to worry, ‘Is it safe to go to this job?’" said Hayes.

Right now, many employers aren't nearly prepared to tell workers in the U.S. to return to work and office spaces. To avoid infection, "the only tools you’ve got in your toolbox are the simple but hard-to-sustain public health tools like testing, contact tracing, and social distancing," explained Michael Gusmano, a health policy expert at the Rutgers School of Public Health.

"We’re not anywhere near a situation where you could claim that you can, with any credibility, send people back en masse now," Gusmano said.

The info is here.

Drivers are blamed more than their automated cars when both make mistakes

Awad, E., Levine, S., Kleiman-Weiner, M. et al.
Nat Hum Behav 4, 134–143 (2020).
https://doi.org/10.1038/s41562-019-0762-8

Abstract

When an automated car harms someone, who is blamed by those who hear about it? Here we asked human participants to consider hypothetical cases in which a pedestrian was killed by a car operated under shared control of a primary and a secondary driver and to indicate how blame should be allocated. We find that when only one driver makes an error, that driver is blamed more regardless of whether that driver is a machine or a human. However, when both drivers make errors in cases of human–machine shared-control vehicles, the blame attributed to the machine is reduced. This finding portends a public under-reaction to the malfunctioning artificial intelligence components of automated cars and therefore has a direct policy implication: allowing the de facto standards for shared-control vehicles to be established in courts by the jury system could fail to properly regulate the safety of those vehicles; instead, a top-down scheme (through federal laws) may be called for.

From the Discussion:

Our central finding (diminished blame apportioned to the machine in dual-error cases) leads us to believe that, while there may be many psychological barriers to self-driving car adoption19, public over-reaction to dual-error cases is not likely to be one of them. In fact, we should perhaps be concerned about public underreaction. Because the public are less likely to see the machine as being at fault in dual-error cases like the Tesla and Uber crashes, the sort of public pressure that drives regulation might be lacking. For instance, if we were to allow the standards for automated vehicles to be set through jury-based court-room decisions, we expect that juries will be biased to absolve the car manufacturer of blame in dual-error cases, thereby failing to put sufficient pressure on manufacturers to improve car designs.

The article is here.

Experiments on Trial

Hannah Fry
The New Yorker
Originally posted 24 Feb 20

Here are two excerpts:

There are also times when manipulation leaves people feeling cheated. For instance, in 2018 the Wall Street Journal reported that Amazon had been inserting sponsored products in its consumers’ baby registries. “The ads look identical to the rest of the listed products in the registry, except for a small gray ‘Sponsored’ tag,” the Journal revealed. “Unsuspecting friends and family clicked on the ads and purchased the items,” assuming they’d been chosen by the expectant parents. Amazon’s explanation when confronted? “We’re constantly experimenting,” a spokesperson said. (The company has since ended the practice.)

But there are times when the experiments go further still, leaving some to question whether they should be allowed at all. There was a notorious experiment run by Facebook in 2012, in which the number of positive and negative posts in six hundred and eighty-nine thousand users’ news feeds was tweaked. The aim was to see how the unwitting participants would react. As it turned out, those who saw less negative content in their feeds went on to post more positive stuff themselves, while those who had positive posts hidden from their feeds used more negative words.

A public backlash followed; people were upset to discover that their emotions had been manipulated. Luca and Bazerman argue that this response was largely misguided. They point out that the effect was small. A person exposed to the negative news feed “ended up writing about four additional negative words out of every 10,000,” they note. Besides, they say, “advertisers and other groups manipulate consumers’ emotions all the time to suit their purposes. If you’ve ever read a Hallmark card, attended a football game or seen a commercial for the ASPCA, you’ve been exposed to the myriad ways in which products and services influence consumers’ emotions.”

(cut)

Medicine has already been through this. In the early twentieth century, without a set of ground rules on how people should be studied, medical experimentation was like the Wild West. Alongside a great deal of good work, a number of deeply unethical studies took place—including the horrifying experiments conducted by the Nazis and the appalling Tuskegee syphilis trial, in which hundreds of African-American men were denied treatment by scientists who wanted to see how the lethal disease developed. As a result, there are now clear rules about seeking informed consent whenever medical experiments use human subjects, and institutional procedures for reviewing the design of such experiments in advance. We’ve learned that researchers aren’t always best placed to assess the potential harm of their work.

The info is here.

Donald Trump: a political determinant of covid-19

Gavin Yamey and Greg Gonsalves
BMJ 2020; 369  (Published 24 April 2020)
doi: https://doi.org/10.1136/bmj.m1643

He downplayed the risk and delayed action, costing countless avertable deaths

On 23 January 2020, the World Health Organization told all governments to get ready for the transmission of a novel coronavirus in their countries. “Be prepared,” it said, “for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread.” Some countries listened. South Korea, for example, acted swiftly to contain its covid-19 epidemic. But US President Donald Trump was unmoved by WHO’s warning, downplaying the threat and calling criticisms of his failure to act “a new hoax.”

Trump’s anaemic response led the US to become the current epicentre of the global covid-19 pandemic, with almost one third of the world’s cases and a still rising number of new daily cases.4 In our interconnected world, the uncontrolled US epidemic has become an obstacle to tackling the global pandemic. Yet the US crisis was an avertable catastrophe.

Dismissing prescient advice on pandemic preparedness from the outgoing administration of the former president, Barack Obama, the Trump administration went on to weaken the nation’s pandemic response capabilities in multiple ways. In May 2018, it eliminated the White House global health security office that Obama established after the 2014-16 Ebola epidemic to foster cross-agency pandemic preparedness. In late 2019, it ended a global early warning programme, PREDICT, that identified viruses with pandemic potential. There were also cuts to critical programmes at the Centers for Disease Control and Prevention (CDC), part and parcel of Trump’s repeated rejections of evidence based policy making for public health.

Denial
After the US confirmed its first case of covid-19 on 22 January 2020, Trump responded with false reassurances, delayed federal action, and the denigration of science. From January to mid-March, he denied that the US faced a serious epidemic risk, comparing the threat to seasonal influenza. He repeatedly reassured Americans that they had nothing to worry about, telling the public: “We think it's going to have a very good ending for us” (30 January), “We have it very much under control in this country” (23 February),
and “The virus will not have a chance against us. No nation is more prepared, or more resilient, than the United States” (11 March).

The info is here.

Punitive but discriminating: Reputation fuels ambiguously-deserved punishment but also sensitivity to moral nuance

Jordan, J., & Kteily, N.
(2020, March 21).
https://doi.org/10.31234/osf.io/97nhj

Abstract

Reputation concerns can motivate moralistic punishment, but existing evidence comes exclusively from contexts in which punishment is unambiguously deserved. Recent debates surrounding “virtue signaling” and “outrage culture” raise the question of whether reputation may also fuel punishment in more ambiguous cases—and even encourage indiscriminate punishment that ignores moral nuance. But when the moral case for punishment is ambiguous, do people actually expect punishing to make them look good? And if so, are people willing to use ambiguously-deserved punishment to gain reputational benefits, or do personal reservations about whether punishment is merited restrain them from doing so? We address these questions across 11 experiments (n = 9448) employing both hypothetical vignette and costly behavioral paradigms. We find that reputation does fuel ambiguously-deserved punishment. Subjects expect even ambiguously-deserved punishment to look good, especially when the audience is highly ideological. Furthermore, despite personally harboring reservations about its morality, subjects readily use ambiguously-deserved punishment to gain reputational benefits. Yet we also find that reputation can do more to fuel unambiguously-deserved punishment. Subjects robustly expect unambiguously-deserved punishment to look better than ambiguously-deserved punishment, even when the audience is highly ideological. And we find evidence that as a result, introducing reputational incentives can preferentially increase unambiguously-deserved punishment—causing punishers to differentiate more between ambiguous and unambiguous cases and thereby heightening sensitivity to moral nuance. We thus conclude that the drive to signal virtue can make people more punitive but also more discriminating, painting a nuanced picture of the role that reputation plays in outrage culture.

From the Discussion:

Here, we have provided a novel framework for understanding the influence of reputational incentives on moralistic punishment in ambiguous and unambiguous cases.By looking beyond contexts in which punishment is unambiguously merited, and by considering the important role of audience ideology,our work fills critical theoretical gaps in our understanding of the human moral psychology surrounding punishment and reputation. Our findings also speak directly to concerns raised by critics of “outrage culture”, who have suggested that “virtue signaling” fuels ambiguously-deserved punishment and even encourages indiscriminate punishment that ignores moral nuance, thereby contributing to negative societal outcomes(e.g., by unfairly harming alleged perpetrators and chilling social discourse). More specifically, our results present a complex portrait of the role that reputation plays in outrage culture, lending credence to some concerns about virtue signaling but casting doubt on others.

COVID-19 Is Making Moral Injury to Physicians Much Worse

Wendy Dean
Medscape.com
Originally published 1 April 20

Here is an excerpt:

Moral injury is also coming to the forefront as physicians consider rationing scarce resources with too little guidance. Which surgeries truly justify use of increasingly scarce PPE? A cardiac valve replacement? A lumpectomy? Repairing a torn ligament?

Each denial has profound impact on both the patients whose surgeries are delayed and the clinicians who decide their fates. Yet worse decisions may await clinicians. If, for example, New York City needs an additional 30,000 ventilators but receives only 500, physicians will be responsible for deciding which 29,500 patients will not be ventilated, virtually assuring their demise.

How will physicians make those decisions? How will they cope? The situation of finite resources will force an immediate pivot to assessing patients according to not only their individual needs but also to society's need for that patient's contribution. It will be a wrenching restructuring.

Here are the essential principles for mitigating the impact of moral injury in the context of COVID-19. (They are the same as recommendations in the time before COVID-19.)

1. Value physicians

a. Physicians are putting everything on the line. They're walking into a wildfire of a pandemic, wearing pajamas, with a peashooter in their holster. That takes a monumental amount of courage and deserves profound respect.

The info is here.