What is herd immunity?

Joshua Krisch
Live Science
Originally published July 2020

Here is an excerpt:

Herd immunity doesn't always work

The ingredients for achieving herd immunity naturally are well understood. "You want a disease that is guaranteed to produce robust immunity with largely asymptomatic spread, and have a low R0," Altmann told Live Science. But even if the R0 is relatively high and most patients are symptomatic, herd immunity is still possible with an effective vaccine, and a vaccine program that immunizes the population en masse. "Think of our big, public-health vaccination success-stories: Smallpox and polio, both entirely due to massive, sustained vaccine programs with simple, highly effective vaccines," he said.

Robust immunity is necessary to ensure that those who become immune stay that way long enough for the pathogen to die out. Asymptomatic spread helps, because it means that fewer people are likely to die while the population waits for herd immunity to take hold — and increases the likelihood that there will be enough survivors to affect herd immunity in the first place. A low R0, of course, lowers the bar for how many individuals need to be immune before we see the infection rate flatten and decline.

Nonetheless, some diseases that are seemingly strong candidates for herd immunity never quite achieve it. Despite widespread infection and vaccination, chicken pox, for instance, has never been entirely eradicated from the population. That's because the virus that causes chicken pox remains latent in the nerve roots of those who are infected by it, even after they recover and acquire immunity to the disease. As once-infected individuals grow older their immune systems weaken and the virus can reactivate, causing shingles, which can, in turn, cause chicken pox.

"You might have eradicated chicken pox in a small island community, but then somebody's granny gets an attack of shingles and, over a matter of weeks, every kid on the island gets chicken pox," Hunter said. "You've achieved herd immunity, and [it appears] the virus has died out, but it's actually waiting to come out." Similar phenomena have been observed with tuberculosis, according to the WHO.

Vaccine-induced herd immunity can also fail when a vaccine results in only short-lived immunity within a population. Pertussis and mumps recently reappeared long after vaccine programs were assumed to have eradicated these diseases, and studies suggest that, while vaccine noncompliance played a role, the outbreaks were in part due to the vaccines losing effectiveness over time. "In the past few years we've had both pertussis and mumps outbreaks, and those have primarily resulted from waning immunity over time," Poland said.

The info is here.

Hydroxychloroquine RCTs: 'Ethically, the Choice Is Clear'

F. Perry Wilson
medscape.com
Originally poste 5 August 20

Here is an excerpt:

I am not going to say that HCQ has no effect on COVID-19. We can never be 100% sure of that. But I am sure that if it has an effect, it is quite small. Think of a world where HCQ was a miracle cure for COVID-19. Think how different all of these randomized trials would look. It would be immediately obvious.

Straight talk: HCQ is unlikely to kill you. It will kill someone (rare cases of torsades de pointes occur), but it is unlikely to be you or your patients. It really is a relatively well-tolerated drug. But there are adverse effects, as all of these trials show. And given that, our ethical obligation to "first, do no harm" is paramount here. There simply is not good evidence that HCQ has a robust effect, and there is evidence of at least moderate harm. Ethically, the choice is clear.

A few final caveats. Yes, only one of these trials reported on the use of zinc with HCQ (no effect, by the way). But two things on that particular issue: First, we know that many individuals take zinc supplements, so if, as the argument goes, HCQ is a miracle cure when given with zinc, you'd still see a benefit in an HCQ trial because a subset of people — maybe 25% — are taking zinc.

The zinc issue falls into this "no true Scotsman" land of HCQ studies. Any negative study can be dismissed: "Oh, you didn't give it early enough, or late enough, or with zinc, or with azithromycin, or on Sunday," or whatever. That's not how science works. I'm not saying that any of these studies are perfect, just that they are the best evidence we have right now. The burden of proof is to show that the drug works. Though I'm sure that pharma would be stoked to be able to argue that their latest negative trial can be ignored because their billion-dollar drug wasn't given in concert with vitamin C or whatever.

Yes, I know that another Yale professor is saying that HCQ can save lives.

And to those of you who have pointed out that he is a full professor while I am a mere associate professor, you really know how to hurt a guy. I have no idea why he wrote that article and didn't mention any of the randomized trials. But I embrace the academic freedom that he and I both have to present our best interpretation of the data.

The info is here.

An approach for combining ethical principles with public opinion to guide public policy

E. Awad and others.
Artificial Intelligence
Volume 287, October 2020, 103349

Abstract

We propose a framework for incorporating public opinion into policy making in situations where values are in conflict. This framework advocates creating vignettes representing value choices, eliciting the public's opinion on these choices, and using machine learning to extract principles that can serve as succinct statements of the policies implied by these choices and rules to guide the behavior of autonomous systems.

From the Discussion

In the general case, we would strongly recommend input from experts (including ethicists, legal scholars, policymakers among others). Still, two facts remain: (1) views on life and death are emotionally driven, so it’s hard for people to accept some authority figure telling them how they should behave; (2) Even from an ethical perspective, it’s not always clear which view is the correct one. In such cases, when policy experts cannot reach a consensus, they may use citizens’ preferences as a tie-breaker. Doing so, helps reach a conclusive decision, it promotes values of democracy, it increases public acceptance of this technology (especially when it provides much better safety), and it promotes their sense of involvement and citizenship.  On the other hand, a full dependence on public input would always have the possibility for tyranny of the majority, among other issues raised above. This is why our proposed method provides a suitable approach that combines the utilization of citizen’s input with the responsible oversight by experts.

In this paper, we propose a framework that can help resolve conflicting moral values. In so doing, we exploit two decades of research in the representation and abstraction of values from cases in the service of abstracting and representing the values expressed in crowd-sourced data to the end of informing public policy. As a results, the resolution of competing values is produced in two forms: one that can be implemented in autonomous systems to guide their behavior, and a human-readable representation (policy) of these rules. At the core of this framework, is the collection of data from the
public.

The Extended Moral Foundations Dictionary (eMFD): Development and Applications

Hopp, F. R., Fisher, J. T., Cornell, D.,
Huskey, R., & Weber, R. (2020, June 12).
https://doi.org/10.3758/s13428-020-01433-0

Abstract

Moral intuitions are a central motivator in human behavior. Recent work highlights the importance of moral intuitions for understanding a wide range of issues ranging from online radicalization to vaccine hesitancy. Extracting and analyzing moral content in messages, narratives, and other forms of public discourse is a critical step toward understanding how the psychological influence of moral judgments unfolds at a global scale. Extant approaches for extracting moral content are limited in their ability to capture the intuitive nature of moral sensibilities, constraining their usefulness for understanding and predicting human moral behavior. Here we introduce the extended Moral Foundations Dictionary (eMFD), a dictionary-based tool for extracting moral content from textual corpora. The eMFD, unlike previous methods, is constructed from text annotations generated by a large sample of human coders. We demonstrate that the eMFD outperforms existing approaches in a variety of domains. We anticipate that the eMFD will contribute to advance the study of moral intuitions and their influence on social, psychological, and communicative processes.

From the Discussion:

In  a  series  of  theoretically-informed  dictionary  validation  procedures,  we  demonstrated  the  eMFD’s increased  utility  compared  to  previous  moral  dictionaries.  First,  we  showed  that  the  eMFD  more accurately  predicts  the  presence  of  morally-relevant  article  topics  compared  to  previous  dictionaries. Second, we showed that the eMFD more effectively detects distinctions between the moral language used by  partisan  news  organizations.  Word  scores  returned  by  the  eMFD  confirm  that  conservative  sources place greater emphasis on the binding moral foundations of loyalty, authority, and sanctity, whereas more liberal  leaning  sources  tend  to  stress  the  individualizing  foundations  of  care  and  fairness,  supporting previous research on moral partisan news framing (Fulgoni et al., 2016). Third, we demonstrated that the eMFD more accurately predicts the share counts of morally-loaded online newspaper articles. The eMFD produced  a  better  model  fit  explained  more  variance  in  overall  share  counts  compared  to  previous approaches.  Finally,  we  demonstrated eMFD score’s  utility  for  linking  moral  actions  to  their  respective moral agents and targets.

How behavioural sciences can promote truth, autonomy and democratic discourse online

Lorenz-Spreen, P., Lewandowsky,
S., Sunstein, C.R. et al.
Nat Hum Behav (2020).
https://doi.org/10.1038/s41562-020-0889-7

Abstract

Public opinion is shaped in significant part by online content, spread via social media and curated algorithmically. The current online ecosystem has been designed predominantly to capture user attention rather than to promote deliberate cognition and autonomous choice; information overload, finely tuned personalization and distorted social cues, in turn, pave the way for manipulation and the spread of false information. How can transparency and autonomy be promoted instead, thus fostering the positive potential of the web? Effective web governance informed by behavioural research is critically needed to empower individuals online. We identify technologically available yet largely untapped cues that can be harnessed to indicate the epistemic quality of online content, the factors underlying algorithmic decisions and the degree of consensus in online debates. We then map out two classes of behavioural interventions—nudging and boosting— that enlist these cues to redesign online environments for informed and autonomous choice.

Here is an excerpt:

Another competence that could be boosted to help users deal more expertly with information they encounter online is the ability to make inferences about the reliability of information based on the social context from which it originates. The structure and details of the entire cascade of individuals who have previously shared an article on social media has been shown to serve as proxies for epistemic quality. More specifically, the sharing cascade contains metrics such as the depth and breadth of dissemination by others, with deep and narrow cascades indicating extreme or niche topics and breadth indicating widely discussed issues. A boosting intervention could provide this information (Fig. 3a) to display the full history of a post, including the original source, the friends and public users who disseminated it, and the timing of the process (showing, for example, if the information is old news that has been repeatedly and artificially amplified). Cascade statistics teaches concepts that may take some practice to read and interpret, and one may need to experience a number of cascades to learn to recognize informative patterns.

Your Ancestors Knew Death in Ways You Never Will

Donald McNeil, Jr.
The New York Times
Originally posted 15 July 20

Here is the end:

As a result, New Yorkers took certain steps — sometimes very expensive and contentious, but all based on science: They dug sewers to pipe filth into the Hudson and East Rivers instead of letting it pool in the streets. In 1842, they built the Croton Aqueduct to carry fresh water to Manhattan. In 1910, they chlorinated its water to kill more germs. In 1912, they began requiring dairies to heat their milk because a Frenchman named Louis Pasteur had shown that doing so spared children from tuberculosis. Over time, they made smallpox vaccination mandatory.

Libertarians battled almost every step. Some fought sewers and water mains being dug through their properties, arguing that they owned perfectly good wells and cesspools. Some refused smallpox vaccines until the Supreme Court put an end to that in 1905, in Jacobson v. Massachusetts.

In the Spanish flu epidemic of 1918, many New Yorkers donned masks but 4,000 San Franciscans formed an Anti-Mask League. (The city’s mayor, James Rolph, was fined $50 for flouting his own health department’s mask order.) Slowly, science prevailed, and death rates went down.

Today, Americans are facing the same choice our ancestors did: We can listen to scientists and spend money to save lives, or we can watch our neighbors die.

“The people who say ‘Let her rip, let’s go for herd immunity’ — that’s just public-health nihilism,” said Dr. Joia S. Mukherjee, the chief medical office of Partners in Health, a medical charity fighting the virus. “How many deaths do we have to accept to get there?”

A vaccine may be close at hand, and so may treatments like monoclonal antibodies that will cut our losses.

Till then, we need not accept death as our overlord — we can simply hang on and outlast him.

The info is here.

Technology Can Help Us, but People Must Be the Moral Decision Makers

Andrew Briggs
medium.com
Originally posted 8 June 20

Here is an excerpt:

Many individuals in technology fields see tools such as machine learning and AI as precisely that — tools — which are intended to be used to support human endeavors, and they tend to argue how such tools can be used to optimize technical decisions. Those people concerned with the social impacts of these technologies tend to approach the debate from a moral stance and to ask how these technologies should be used to promote human flourishing.

This is not an unresolvable conflict, nor is it purely academic. As the world grapples with the coronavirus pandemic, society is increasingly faced with decisions about how technology should be used: Should sick people’s contacts be traced using cell phone data? Should AIs determine who can or cannot work or travel based on their most recent COVID-19 test results? These questions have both technical and moral dimensions. Thankfully, humans have a unique capacity for moral choices in a way that machines simply do not.

One of our findings is that for humanity to thrive in the new digital age, we cannot disconnect our technical decisions and innovations from moral reasoning. New technologies require innovations in society. To think that the advance of technology can be stopped, or that established moral modalities need not be applied afresh to new circumstances, is a fraught path. There will often be tradeoffs between social goals, such as maintaining privacy, and technological goals, such as identifying disease vectors.

The info is here.

Five tips for transitioning your practice to telehealth

Rebecca Clay
American Psychological Association
Originally posted 19 June 20

When COVID-19 forced Boston private practitioner Luana Bessa, PhD, to take her practice Bela Luz Health online in March, she was worried about whether she could still have deep, meaningful connections with patients through a screen.

To her surprise, Bessa’s intimacy with patients increased instead of diminished. While she is still mindful of maintaining the therapeutic “frame,” it can be easier for everyday life to intrude on that frame while working virtually. But that’s OK, says Bessa. “I’ve had clients tell me, ‘It makes you more human when I see your cat jump on your lap,’” she laughs. “It has really enriched my relationships with some clients.”

Bessa and others recommend several ways to ensure that the transition to telehealth is a positive experience for both you and your patients.

Protect your practice’s financial health

Make sure your practice will be viable so that you continue serving patients over the long haul. If you have an office sitting idle, for example, see if your landlord will renegotiate or suspend lease payments, suggests Kimberly Y. Campbell, PhD, of Campbell Psychological Services, LLC, in Silver Spring, Maryland. Also renegotiate agreements with other vendors, such as parking lot owners, cleaning services, and the like.

And since patients can’t just hand you or your receptionist a credit card, you’ll need to set up an alternate payment system. Campbell turned to a credit card processing company called Clover. Other practitioners use the payment system that’s part of their electronic health record system. Natasha Holmes, PsyD, uses SimplePractice to handle payment for her Boston practice And Still We Rise, LLC. Although there’s a fee for processing payments, an integrated program makes payment as easy as clicking a button after a patient’s session and watching the payment show up at your bank the next day.

The info is here.

Influencing choices with conversational primes: How a magic trick unconsciously influences card choices

Alice Pailhès and Gustav Kuhn
PNAS, Jul 2020, 202000682
DOI: 10.1073/pnas.2000682117

Abstract

Past research demonstrates that unconscious primes can affect people’s decisions. However, these free choice priming paradigms present participants with very few alternatives. Magicians’ forcing techniques provide a powerful tool to investigate how natural implicit primes can unconsciously influence decisions with multiple alternatives. We used video and live performances of the mental priming force. This technique uses subtle nonverbal and verbal conversational primes to influence spectators to choose the three of diamonds. Our results show that a large number of participants chose the target card while reporting feeling free and in control of their choice. Even when they were influenced by the primes, participants typically failed to give the reason for their choice. These results show that naturally embedding primes within a person’s speech and gestures effectively influenced people’s decision making. This raises the possibility that this form of mind control could be used to effectively manipulate other mental processes.

Significance

This paper shows that naturally embedding primes within a person’s speech and gestures effectively influences people’s decision making. Likewise, our results dovetail findings from choice blindness literature, illustrating that people often do not know the real reason for their choice. Magicians’ forcing techniques may provide a powerful and reliable way of studying these mental processes, and our paper illustrates how this can be done. Moreover, our results raise the possibility that this form of mind control could be used to effectively manipulate other mental processes.

A pdf of the research can be found here.

Editor's Note: This research has implications of how psychologists may consciously or unconsciously influence patient choices.