There are no good choices

Ezra Klein
vox.com
Originally published 14 Sept 20

Here is an excerpt:

In America, our ideological conflicts are often understood as the tension between individual freedoms and collective actions. The failure of our pandemic response policy exposes the falseness of that frame. In the absence of effective state action, we, as individuals, find ourselves in prisons of risk, our every movement stalked by disease. We are anything but free; our only liberty is to choose among a menu of awful options. And faced with terrible choices, we are turning on each other, polarizing against one another. YouTube conspiracies and social media shaming are becoming our salves, the way we wrest a modicum of individual control over a crisis that has overwhelmed us as a collective.

“The burden of decision-making and risk in this pandemic has been fully transitioned from the top down to the individual,” says Dr. Julia Marcus, a Harvard epidemiologist. “It started with [responsibility] being transitioned to the states, which then transitioned it to the local school districts — If we’re talking about schools for the moment — and then down to the individual. You can see it in the way that people talk about personal responsibility, and the way that we see so much shaming about individual-level behavior.”

But in shifting so much responsibility to individuals, our government has revealed the limits of individualism.

The risk calculation that rules, and ruins, lives

Think of coronavirus risk like an equation. Here’s a rough version of it: The danger of an act = (the transmission risk of the activity) x (the local prevalence of Covid-19) / (by your area’s ability to control a new outbreak).

Individuals can control only a small portion of that equation. People can choose safer activities over riskier ones — though the language of choice too often obscures the reality that many have no economic choice save to work jobs that put them, and their families, in danger. But the local prevalence of Covid-19 and the capacity of authorities to track and squelch outbreaks are collective functions.

The info is here.

The Panopticon Is Already Here

Ross Anderson
The Atlantic
Originally published September 2020

Here is an excerpt:

China is an ideal setting for an experiment in total surveillance. Its population is extremely online. The country is home to more than 1 billion mobile phones, all chock-full of sophisticated sensors. Each one logs search-engine queries, websites visited, and mobile payments, which are ubiquitous. When I used a chip-based credit card to buy coffee in Beijing’s hip Sanlitun neighborhood, people glared as if I’d written a check.

All of these data points can be time-stamped and geo-tagged. And because a new regulation requires telecom firms to scan the face of anyone who signs up for cellphone services, phones’ data can now be attached to a specific person’s face. SenseTime, which helped build Xinjiang’s surveillance state, recently bragged that its software can identify people wearing masks. Another company, Hanwang, claims that its facial-recognition technology can recognize mask wearers 95 percent of the time. China’s personal-data harvest even reaps from citizens who lack phones. Out in the countryside, villagers line up to have their faces scanned, from multiple angles, by private firms in exchange for cookware.

Until recently, it was difficult to imagine how China could integrate all of these data into a single surveillance system, but no longer. In 2018, a cybersecurity activist hacked into a facial-recognition system that appeared to be connected to the government and was synthesizing a surprising combination of data streams. The system was capable of detecting Uighurs by their ethnic features, and it could tell whether people’s eyes or mouth were open, whether they were smiling, whether they had a beard, and whether they were wearing sunglasses. It logged the date, time, and serial numbers—all traceable to individual users—of Wi-Fi-enabled phones that passed within its reach. It was hosted by Alibaba and made reference to City Brain, an AI-powered software platform that China’s government has tasked the company with building.

City Brain is, as the name suggests, a kind of automated nerve center, capable of synthesizing data streams from a multitude of sensors distributed throughout an urban environment. Many of its proposed uses are benign technocratic functions. Its algorithms could, for instance, count people and cars, to help with red-light timing and subway-line planning. Data from sensor-laden trash cans could make waste pickup more timely and efficient.

The info is here.

Morality has been stripped from public life. Here’s a four-step plan to revive it

Roger Paxton
TheGuardian.com
Originally posted 13 Sept 20

Here is an excerpt:

From the top down, public morality is corroded. If morality, not to mention competence, were valued by the electorate, the approval ratings of Boris Johnson (and Donald Trump) would surely have plummeted, but they haven’t. As others have noted, for many people truth has become unimportant. Selfishness is assumed and encouraged, and opponents, dissenters and people seen as “other” are denigrated and worse. The most important thing is one’s own short-term interest.

What can be done about the crisis? Of course a new government is needed, but even if a Labour government is elected, the divisions and the damage done to public morality will need to be repaired. Just as there is a need to promote physical and mental wellbeing, so morality could be promoted by means of the concept of moral wellbeing.

For physical wellbeing, we have the dietary advice of five-a-day; for mental wellbeing the New Economics Foundation’s five ways to wellbeing, as used by the NHS. For moral wellbeing there is a similar framework that could be useful: the psychological model developed by James Rest, outlining the four components of moral reasoning.

This is a framework for improving thoughtfulness and clarity about moral matters. The first stage is moral sensitivity – recognising when an issue is one of morality, rather than a personal preference or practicality. The second component is moral reasoning. Having identified that a question is one of right and wrong, you then decide what the right thing to do would be. Third comes moral motivation – acknowledging other interests and motives that influence your thinking about the issue, and then weighing up the conflicting motives. The fourth and final stage is moral implementation, which means bringing moral reasoning and moral motivation together to make and act on a decision.

The information is here.

Is Morality All About Cooperation?

John Danaher
philosophicaldiquisitions.com
Originally posted 27 July 20

Here are two excerpts:

Morality as Cooperation (MAC): The Basic Theory

MAC takes as its starting point the view that human morality is about cooperation. In itself, this is not a particularly ground-breaking insight. Most moral philosophers have thought that morality has something to do with how we interact with other people — with “what we owe each other” in one popular formulation. Scott Curry, in his original paper on the MAC, does a good job reviewing some of the major works in moral philosophy and moral psychology, showing how each of them tends to link morality to cooperation.

Some people might query this and say that certain aspects of human morality don’t seem to be immediately or obviously about cooperation, but one of the claims of MAC is that these seemingly distinctive areas of morality can ultimately be linked back to cooperation. For what it is worth, I am willing to buy the idea that morality is about cooperation as a starting hypothesis. I have some concerns, which I will air below, but even if these concerns are correct I think it is fair to say that morality is, in large part, about cooperation.

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In summary, the idea behind the MAC is that human moral systems derive from attempts to resolve cooperative problems. There are seven basic cooperative problems and hence seven basic forms of human morality. These are often blended and combined in actual human societies (more on this in a moment), nevertheless you can still see the pure forms of these moral systems in many different societies. The diagram below summarises the model and gives some examples of the ethical norms that derive from the different cooperative problems.

The blog post is here.

Trump lied about science

H. Holden Thorp
Science
Originally published 11 Sept 20

When President Donald Trump began talking to the public about coronavirus disease 2019 (COVID-19) in February and March, scientists were stunned at his seeming lack of understanding of the threat. We assumed that he either refused to listen to the White House briefings that must have been occurring or that he was being deliberately sheltered from information to create plausible deniability for federal inaction. Now, because famed Washington Post journalist Bob Woodward recorded him, we can hear Trump’s own voice saying that he understood precisely that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was deadly and spread through the air. As he was playing down the virus to the public, Trump was not confused or inadequately briefed: He flat-out lied, repeatedly, about science to the American people. These lies demoralized the scientific community and cost countless lives in the United States.

Over the years, this page has commented on the scientific foibles of U.S. presidents. Inadequate action on climate change and environmental degradation during both Republican and Democratic administrations have been criticized frequently. Editorials have bemoaned endorsements by presidents on teaching intelligent design, creationism, and other antiscience in public schools. These matters are still important. But now, a U.S. president has deliberately lied about science in a way that was imminently dangerous to human health and directly led to widespread deaths of Americans.

This may be the most shameful moment in the history of U.S. science policy.

In an interview with Woodward on 7 February 2020, Trump said he knew that COVID-19 was more lethal than the flu and that it spread through the air. “This is deadly stuff,” he said. But on 9 March, he tweeted that the “common flu” was worse than COVID-19, while economic advisor Larry Kudlow and presidential counselor Kellyanne Conway assured the public that the virus was contained. On 19 March, Trump told Woodward that he did not want to level with the American people about the danger of the virus. “I wanted to always play it down,” he said, “I still like playing it down.” Playing it down meant lying about the fact that he knew the country was in grave danger.

The info is here.

Correlation not Causation: The Relationship between Personality Traits and Political Ideologies

B. Verhulst, L. J. Evans, & P. K. Hatemi
Am J Pol Sci. 2012 ; 56(1): 34–51.

Abstract

The assumption in the personality and politics literature is that a person's personality motivates them to develop certain political attitudes later in life. This assumption is founded on the simple correlation between the two constructs and the observation that personality traits are genetically influenced and develop in infancy, whereas political preferences develop later in life. Work in psychology, behavioral genetics, and recently political science, however, has demonstrated that political preferences also develop in childhood and are equally influenced by genetic factors. These findings cast doubt on the assumed causal relationship between personality and politics. Here we test the causal relationship between personality traits and political attitudes using a direction of causation structural model on a genetically informative sample. The results suggest that personality traits do not cause people to develop political attitudes; rather, the correlation between the two is a function of an innate common underlying genetic factor.

From the Discussion section

Based on the current results, the claim that personality traits lead to political orientations should no longer be assumed, but explicitly tested for each personality and political trait prior to making any claims about their relationship. We recognize that no single analysis can provide a definitive answer to such a complex question, and our analysis did not include the Agreeableness, Conscientiousness, and Openness Five-Factor Model measures. Future studies which use different personality measures, or other methodological designs, including panel studies that examine the developmental trajectories of personality and attitudes from childhood to adulthood, would be invaluable for investigating more nuanced relationships between personality traits and political attitudes. These would also include models which capture the nonrandom selection into environments that foster the development of more liberal or conservative political attitudes (active gene-environment covariation) as well as the possibility for differential expression of personality traits and political attitudes at different stages of the developmental process that may illuminate “critical periods” for the interface of personality and attitudes.

A link to the pdf can be found on this page.

Psychotherapy, placebos, and informed consent

Leder G
Journal of Medical Ethics 
Published Online First: 20 August 2020.
doi: 10.1136/medethics-2020-106453

Abstract

Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients’ ability to give informed consent to treatment. This ‘deception’ claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments (eg, expectancy effects and therapist effects), rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of psychotherapy have a duty to ‘go open’ to patients about the role of common factors in therapy (even if this risks negatively affecting the efficacy of treatment); to not ‘go open’ is supposed to unjustly restrict patients’ autonomy. This paper makes two related arguments against the ‘go open’ claim. (1) While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners ‘go open’ about therapeutic common factors in psychotherapy, and (2) clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to ‘go open’ should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works.

Conclusion

The ‘go open’ argument is based on a mistaken view about the mechanisms of change in psychotherapy and threatens to harm patients by undermining their ability to make informed treatment decisions. This paper has argued that the prima facie ethical problem raised by the ‘go open’ argument is diffused if we clear up a conceptual confusion about what, exactly, we should be
going open about. Therapists should be open with patients about the differing theories of the mechanisms of change in psychotherapy; this can, but need not involve discussing information
about the therapeutic common factors.

The article is here.

Note from Dr. Gavazzi: Using "deception" is the wrong frame for this issue.  How complete is your informed consent?  Can we ever give "perfect" informed consent?  The answer is likely no.

Why Being Kind Helps You, Too—Especially Now

Elizabeth Bernstein
The Wall Street Journal
Originally posted 11 August 20

Here is an excerpt:

Kindness can even change your brain, says Stephanie Preston, a psychology professor at the University of Michigan who studies the neural basis for empathy and altruism. When we’re kind, a part of the reward system called the nucleus accumbens activates—our brain responds the same way it would if we ate a piece of chocolate cake. In addition, when we see the response of the recipient of our kindness—when the person thanks us or smiles back—our brain releases oxytocin, the feel-good bonding hormone. This oxytocin boost makes the pleasure of the experience more lasting.

It feels so good that the brain craves more. “It’s an upward spiral—your brain learns it’s rewarding, so it motivates you to do it again,” Dr. Preston says.

Are certain acts of kindness better than others? Yes. If you want to reap the personal benefits, “you need to be sincere,” says Sara Konrath, a psychologist and associate professor at the Indiana University Lilly Family School of Philanthropy, where she runs a research lab that studies empathy and altruism.

It also helps to expect good results. A study published in the Journal of Positive Psychology in 2019 showed people who believed that kindness is good for them showed a greater increase in positive emotions, satisfaction with life and feelings of connection with others—as well as a greater decrease in negative emotions—than those who did not.

How can you be kind even when you may not feel like it? Make it a habit. Take stock of how you behave day to day. Are you trusting and generous? Or defensive and hostile? “Kindness is a lifestyle,” says Dr. Konrath.

Start by being kind to yourself—you’re going to burn out if you help everyone else and neglect your own needs. Remember that little acts add up: a smile, a phone call to a lonely friend, letting someone have the parking space. Understand the difference between being kind and being nice—kindness is genuinely helping or caring about someone; niceness is being polite. Don’t forget your loved ones. Kindness is not just for strangers.

The info is here.

Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter

Zulman DM, Haverfield MC, Shaw JG, et al.
JAMA. 2020;323(1):70–81.
doi:10.1001/jama.2019.19003

Key Points

Question  What are the most promising practices to foster physician presence and connection with patients?

Findings  This mixed-methods study identified 5 practices that may enhance physician presence and meaningful connection with patients in the clinical encounter: (1) prepare with intention; (2) listen intently and completely; (3) agree on what matters most; (4) connect with the patient’s story; and (5) explore emotional cues.

Meaning  For busy clinicians with multiple demands and distractions, 5 recommended practices have the potential to facilitate meaningful interactions with patients.

Abstract
Importance  Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.

Objective  To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.

Evidence Review  Preliminary practices were derived through a systematic literature review (fromJanuary 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (−4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their “top 5” practices from among those with median ratings of at least +2 for all 3 criteria. Finalrecommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes.

Findings  The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient’s story (consider life circumstances that influence the patient’s health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient’s emotions).

Conclusions and Relevance  This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

The research is here.