Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge

Jonathan M. Metzl and Dorothy E. Roberts
Virtual Mentor. 2014;16(9):674-690.
doi: 10.1001/virtualmentor.2014.16.9.spec1-1409.

Here is an excerpt:

The Clinical Implications of Addressing Race from a Structural Perspective

These brief case examples illustrate the complex ways that seemingly clinically relevant “cultural” characteristics and attitudes also reflect structural inequities, medical politics, legal codes, invisible discrimination, and socioeconomic disparities. Black men who appeared schizophrenic to medical practitioners did so in part because of the framing of new diagnostic codes. Lower-income persons who “refused” to eat well or exercise lived in neighborhoods without grocery stores or sidewalks. Black women who seemed to be uniquely harming their children by using crack cocaine while pregnant were victims of racial stereotyping, as well as of a selection bias in which decisions about which patients were reported to law enforcement depended on the racial and economic segregation of prenatal care. In this sense, approaches that attempt to address issues—such as the misdiagnosis of schizophrenia in black men, perceived diet “noncompliance” in minority populations, or the punishment of “crack mothers”—through a heuristic aimed solely at enhancing cross-cultural communication between doctors and patients, though surely well intentioned, will overlook the potentially pathologizing impact of structural factors set in motion long before patients or doctors enter exam rooms.

Structural factors impact majority populations as well as minority ones, and structures of privilege or opulence also influence expressions of illness and health. For instance, in the United States, research suggests that pediatricians disproportionately overdiagnose ADHD in white school-aged children. Until recently, medical researchers in many global locales assumed, wrongly, that eating disorders afflicted only affluent persons.

Yet of late, medicine and medical education have struggled most with addressing ways that structural forces impact and disadvantage communities of color. As sociologist Hannah Bradby rightly explains it, hypothesizing mechanisms that include the micro-processes of interactions between patients and professionals and the macro-processes of population-level inequalities is a missing step in our reasoning at present…. [A]s long as we see the solution to racism lying only in educating the individual, we fail to address the complexity of racism and risk alienating patients and physicians alike.

The info is here.

Survival of the Friendliest: Homo sapiens Evolved via Selection for Prosociality

Brian Hare
Annu. Rev. Psychol. 2017.68:155-186.

Abstract

The challenge of studying human cognitive evolution is identifying unique features of our intelligence while explaining the processes by which they arose. Comparisons with nonhuman apes point to our early-emerging cooperative-communicative abilities as crucial to the evolution of all forms of human cultural cognition, including language. The human self-domestication hypothesis proposes that these early-emerging social skills evolved when natural selection favored increased in-group prosociality over aggression in late human evolution. As a by-product of this selection, humans are predicted to show traits of the domestication syndrome observed in other domestic animals. In reviewing comparative, developmental, neurobiological, and paleoanthropological research, compelling evidence emerges for the predicted relationship between unique human mentalizing abilities, tolerance, and the domestication syndrome in humans. This synthesis includes a review of the first a priori test of the self-domestication hypothesis as well as predictions for future tests.

A pdf can be downloaded from here.

Does encouraging a belief in determinism increase cheating?

Nadelhoffer, T., and others
(2019, May 3).
https://doi.org/10.1016/j.cognition.2020.104342

Abstract

A key source of support for the view that challenging people’s beliefs about free will may undermine moral behavior is two classic studies by Vohs and Schooler (2008). These authors reported that exposure to certain prompts suggesting that free will is an illusion increased cheating behavior. In the present paper, we report several attempts to replicate this influential and widely cited work. Over a series of five studies (sample sizes of N = 162, N = 283, N = 268, N = 804, N = 982) (four preregistered) we tested the relationship between (1) anti-free-will prompts and free will beliefs and (2) free will beliefs and immoral behavior. Our primary task was to closely replicate the findings from Vohs and Schooler (2008) using the same or highly similar manipulations and measurements as the ones used in their original studies. Our efforts were largely unsuccessful. We suggest that manipulating free will beliefs in a robust way is more difficult than has been implied by prior work, and that the proposed link with immoral behavior may not be as consistent as previous work suggests.

Most Americans don’t believe they need God to be good: poll

Leonardo Blair
ChristianPost.com
Originally posted 22 July 20

Here is an excerpt:

While 70% of Americans still believe that religion is either “somewhat important” or “very important” in their lives, more than half (54%) of Americans said they believe God is “not necessary to be moral or have good values.”

Meanwhile, 44% of American respondents said they believe God is necessary to “be moral and have good values.”

Respondents on the ideological right were found to be significantly more likely to say it is necessary to believe in God to be a moral person and have good values compared to those on the political left in 15 of the 34 countries surveyed.

The largest gap between the ideological right and left exists in the United States.

While only 24% of American respondents who identified themselves as leaning more to the left politically said it is necessary to believe in God to be moral and have good values, 37% of centrists agreed.

But when it comes to respondents who lean to the right politically, more than twice the percentage of those on the left (63%) agreed that it is necessary to believe in God to be moral and have good values.

The info is here.

Doctors are seen as Godlike: Moral typecasting in medicine

A. Goranson, P. Sheeran, J. Katz, & K. Gray
Social Science & Medicine
Available online 25 May 2020, 113008

Abstract

Doctors are generally thought of as very intelligent and capable. This perception has upsides—doctors are afforded respect and esteem—but it may also have downsides, such as neglecting the mental and physical health of physicians. Two studies examine how Americans “typecast” doctors as Godlike “thinkers” who help others, rather than as vulnerable “feelers” who might themselves need help.

Highlights

• Americans view doctors as godlike and invulnerable.

• Doctors are seen as more agentic than other working professionals.

• Doctors are seen as able to ignore mental and physical health problems.

• Moral typecasting in medicine leads people to neglect doctors' suffering.

From the Discussion

Indeed, doctors are seen as equal to God in their capacity to think, exert self-control, remember details, and plan for the future (see Figure 1). Past work reveals that people typecast those who help others both high in agency and low in experience—which makes them invulnerable to injury and insult, and relatively incapable of suffering (K. Gray & Wegner, 2009). Our results confirm the existence of moral typecasting in medicine: compared to other working adults, people see doctors as less sensitive to pain, fear, embarrassment, and hunger (see Figure 2). We further find that these perceptions of super-human doctors extend outside of work and into global perceptions of physicians’ traits and abilities. This work adds to other research arguing that people do not want to acknowledge the feelings of healthcare providers, because this would make providers less capable of serving our health-related goals (Schroeder & Fishbach, 2015).

A pdf of the research is here.

The trolley problem problem

James Wilson
aeon.com
Originally posted 20 May 20

Here is an excerpt:

Some philosophers think that ethical thought experiments either are, or have a strong affinity with, scientific experiments. On such a view, thought experiments, like other experiments, when well-designed can allow knowledge to be built via rigorous and unbiased testing of hypotheses. Just as in the randomised controlled trials in which new pharmaceuticals are tested, the circumstances and the types of control in thought experiments could be such as to make the situation very unlike everyday situations, but that is a virtue rather than a vice, insofar as it allows ethical hypotheses to be tested cleanly and rigorously.

If thought experiments are – literally – experiments, this helps to explain how they might provide insights into the way the world is. But it would also mean that thought experiments would inherit the two methodological challenges that attend to experiments more generally, known as internal and external validity. Internal validity relates to the extent to which an experiment succeeds in providing an unbiased test of the variable or hypothesis in question. External validity relates to the extent to which the results in the controlled environment translate to other contexts, and in particular to our own. External validity is a major challenge, as the very features that make an environment controlled and suitable to obtain internal validity often make it problematically different from the uncontrolled environments in which interventions need to be applied.

There are significant challenges with both the internal and the external validity of thought experiments. It is useful to compare the kind of care with which medical researchers or psychologists design experiments – including validation of questionnaires, double-blinding of trials, placebo control, power calculations to determine the cohort size required and so on – with the typically rather more casual approach taken by philosophers. Until recently, there has been little systematic attempt within normative ethics to test variations of different phrasing of thought experiments, or to think about framing effects, or sample sizes; or the extent to which the results from the thought experiment are supposed to be universal or could be affected by variables such as gender, class or culture. A central ambiguity has been whether the implied readers of ethical thought experiments should be just anyone, or other philosophers; and, as a corollary, whether judgments elicited are supposed to be expert judgments, or the judgments of ordinary human beings. As the vast majority of ethical thought experiments in fact remain confined to academic journals, and are tested only informally on other philosophers, de facto they are tested only on those with expertise in the construction of ethical theories, rather than more generally representative samples or those with expertise in the contexts that the thought experiments purport to describe.

The info is here.

America’s Schools Are a Moral and Medical Catastrophe

Laurie Garrett
foreignpolicy.com
Originally posted 24 July 20

After U.S. President Donald Trump demanded last week that schools nationwide reopen this fall, regardless of the status of their community’s COVID-19 epidemic status, his Secretary of Education Betsy DeVos was asked how this could safely be accomplished. She offered no guidelines, nor financial support to strapped school districts. Her reply was that school districts nationwide needed to create their own safety schemes and realize that the federal government will cut off funds if schools fail to reopen. “I think the go-to needs to be kids in school, in person, in the classroom,” she said in an interview on CNN on July 12.

This is nothing short of moral bankruptcy. The Trump administration is effectively demanding schools bend to its will, without offering a hint of expert guidance on how to do so safely, much less the necessary financing.

I can’t correct for the latter failure, of course. But here’s some information that will be of use to the many rightfully concerned parents and educators across the United States.

1. Should a national-scale school reopening be considered, at all?

Emphatically, no. The state of Florida’s data shows that 13 percent of children who have been tested for the novel coronavirus were found to be infected, and there’s a gradient of infection downward with age: Only 16 percent of these positive cases are in children 1 to 4 years old, whereas 29 percent are in those 15 to 17 years old. In Nueces County, Texas, 85 children under age 2 have tested positive for the coronavirus since March, killing one of them. The infections were likely caught from parents or older siblings. A South Korean government survey of 60,000 households discovered that adults living in households that had an infected child aged 10 to 19 years had the highest rate of catching the coronavirus—more so than when an infected adult was present. Nearly 19 percent of people living with an infected teenager went on to test positive for the virus within 10 days. A Kaiser Family Foundation study says some 3.3 million adults over 65 in the United States live in a home with at least one school-aged child, putting the elders at special risk.

The info is here.

These Evangelical Women Are Abandoning Trump and the Church

Sara Stankorb
gen.medium.com
Originally posted 23 July 20

Here is an excerpt:

In exit polls from the 2016 election, 80% of white evangelicals and the majority of self-identified Christians said they voted for Donald Trump. The thrice-married, profane, biblically illiterate, sexually predacious candidate mirrored no beatitudes. While some believers rejected Trump for lack of decency, for many Christian voters, his personal failings were not disqualifying — here, at last, was a president who could muscle forward their political interests.

In her 2019 book, Red State Christians, journalist and Lutheran pastor Angela Denker describes traveling across the country after the election, talking to Christian voters and trying to understand their relationship with Donald Trump. Denker argues Trump may not know much about the Bible or evangelical Christianity, but his rhetoric resonated with a civic religion common in many Evangelical churches, especially in the South, “with its unique blend of nostalgia, plus a little misogyny and dog-whistle race politics on the side.” There’s a degree to which many churches have adopted a Christian nationalism that has wrapped faith tightly in patriotism and relies, in some cases, less on the gospel and more on “God, guns, and country.”

Many Southern Baptist churches celebrate the Sundays closest to the Fourth of July and Veterans Day with as much fervor as Easter, with services that might feature the Pledge of Allegiance, “The Star-Spangled Banner,” sermons on American exceptionalism, and video montages of war veterans. It’s a church-country linkage popularized during the Cold War, a perceived battle against threats to “Christian America” rooted in a dominionist theology that portrays the white European settlement of America as a fulfillment of God’s promise. Winning the culture wars and “restoring” Christian political primacy became a spiritual mandate, a restoration of God’s promise. By the time Obama’s administration championed same-sex marriage and birth control coverage, “Democrats sounded like foreigners to Red State Christians across the South and rural America,” writes Dennker.

The info is here.

Developing judgments about peers' obligation to intervene

Marshall, J., Mermin-Bunnell, K, & Bloom, P.
Cognition
Volume 201, August 2020, 104215

Abstract

In some contexts, punishment is seen as an obligation limited to authority figures. In others, it is also a responsibility of ordinary citizens. In two studies with 4- to 7-year-olds (n = 232) and adults (n = 76), we examined developing judgments about whether certain individuals, either authority figures or peers, are obligated to intervene (Study 1) or to punish (Study 2) after witnessing an antisocial action. In both studies, children and adults judged authority figures as obligated to act, but only younger children judged ordinary individuals as also obligated to do so. Taken together, the present findings suggest that younger children, at least in the United States, start off viewing norm enforcement as a universal responsibility, entrusting even ordinary citizens with a duty to intervene in response to antisocial individuals. Older children and adults, though, see obligations as role-dependent—only authority figures are obligated to intervene.

The research is here.