Health Care in the U.S. Compared to Other High-Income Countries: Worst Outcomes

The Commonwealth Fund

Mirror, Mirror 2021: Reflecting Poorly

Originally posted 4 Aug 21

Introduction

No two nations are alike when it comes to health care. Over time, each country has settled on a unique mix of policies, service delivery systems, and financing models that work within its resource constraints. Even among high-income nations that have the option to spend more on health care, approaches often vary substantially. These choices affect health system performance in terms of access to care, patients’ experiences with health care, and people’s health outcomes. In this report, we compare the health systems of 11 high-income countries as a means to generate insights about the policies and practices that are associated with superior performance.

With the COVID-19 pandemic imposing an unprecedented stress test on the health care and public health systems of all nations, such a comparison is especially germane. Success in controlling and preventing infection and disease has varied greatly. The same is true of countries’ ability to address the challenges that the pandemic has presented to the workforce, operations, and financial stability of the organizations delivering care. And while the comparisons we draw are based on data collected prior to the pandemic or during the earliest months of the crisis, the prepandemic strengths and weaknesses of each country’s preexisting arrangements for health care and public health have undoubtedly been shaping its experience throughout the crisis.

For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains:

• Access to care
• Care process
• Administrative efficiency
• Equity
• Health care outcomes

For more information on these performance domains and their component measures, see How We Measured Performance. Most of the data were drawn from surveys examining how members of the public and primary care physicians experience health care in their respective countries. These Commonwealth Fund surveys were conducted by SSRS in collaboration with partner organizations in the 10 other countries. Additional data were drawn from the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

The info is here.

Spreading False Vax Info Might Cost You Your Medical License

Ryan Basen

Medpagetoday.com

Originally posted 3 Aug 21

Physicians who intentionally spread misinformation or disinformation about the COVID-19 vaccines could be disciplined by state medical boards and may have their licenses suspended or taken away, said the Federation of State Medical Boards (FSMB).

Due "to a dramatic increase in the dissemination of COVID-19 vaccine misinformation and disinformation by physicians and other health care professionals on social media platforms, online and in the media," the FSMB, a national nonprofit representing medical boards that license and discipline allopathic and osteopathic physicians, issued the following statement:

Physicians who willfully generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded and consensus driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.

The FSMB is aiming to remind physicians that words matter, that they have a platform, and that misinformation and disinformation -- especially within the context of the pandemic -- can cause harm, said president and CEO Humayun Chaudhry, DO. "I hope that physicians and other licensees get the message," he added.

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Character-Infused Ethical Decision Making

Nguyen, B., Crossan, M. 

J Bus Ethics (2021). 

https://doi.org/10.1007/s10551-021-04790-8

Abstract

Despite a growing body of research by management scholars to understand and explain failures in ethical decision making (EDM), misconduct prevails. Scholars have identified character, founded in virtue ethics, as an important perspective that can help to address the gap in organizational misconduct. While character has been offered as a valid perspective in EDM, current theorizing on how it applies to EDM has not been well developed. We thus integrate character, founded in virtue ethics, into Rest’s (1986) EDM model to reveal how shifting attention to the nature of the moral agent provides critical insights into decision making more broadly and EDM specifically. Virtue ethics provides a perspective on EDM that acknowledges and anticipates uncertainties, considers its contextual constraints, and contemplates the development of the moral agent. We thus answer the call by many scholars to integrate character in EDM in order to advance the understanding of the field and suggest propositions for how to move forward. We conclude with implications of a character-infused approach to EDM for future research.

From the Conclusion

As described at the outset, misconduct occurs in every facet of organizational life from the individual to the collective, at a localized and global scale, and covers inappropriate action in the private (2008 financial crisis), public/government (Panama Papers), academic institutions (Varsity Blues Scandal), and even touches not-for-profit organizations (IOC doping scandal). Character highlights the fact that misconduct often arises from “too much of a good thing” (Antonakis et al., 2017); when one or a set of character dimensions are privileged over the others, leading to deficiencies in those undervalued dimensions. For example, those who contributed to the financial crisis and the Panama Paper scandal were likely high on drive but deficient in justice and humanity. Thus, future research could insert character into the equation to better understand the nature of misconduct.

The paper is here.

White and minority demographic shifts, intergroup threat, and right-wing extremism

Bai, H., & Federico, C. M.

(2021). Journal of Experimental Social Psychology

Volume 94, May 2021, 104114

Abstract

We present four studies (one correlational and three experimental) of American Whites that examine relationships between White and minority demographic shifts, intergroup threat, and support for extreme-right groups and actions. We focus in particular on the role of collective existential threat (i.e., a perception that the ingroup will cease to exist), along with three alternative/competing intergroup threats: status threat, symbolic threat, and prototypicality threat. Though no zero-order relationship was found between perceived White population decline and far-right variables, we find evidence that (1) perceived White population decline leads to collective existential threat net of other perceived demographic shifts, (2) collective existential threat is related to far-right support net of other threats, and (3) perceived White decline has a robust indirect relationship with measures of far-right support via collective existential threat.

Highlights

• Perceived White population decline leads to collective existential threat net of other perceived demographic shifts.

• Existential threat is related to far-right support net of other threats.

• Perceived White population decline has a robust indirect relationship with measures of far-right support via collective existential threat.

A pdf is here.

Technological seduction and self-radicalization

Alfano, M., Carter, J., & Cheong, M. (2018). 

Journal of the American Philosophical Association, 

4(3), 298-322. doi:10.1017/apa.2018.27

Abstract

Many scholars agree that the Internet plays a pivotal role in self-radicalization, which can lead to behaviors ranging from lone-wolf terrorism to participation in white nationalist rallies to mundane bigotry and voting for extremist candidates. However, the mechanisms by which the Internet facilitates self-radicalization are disputed; some fault the individuals who end up self-radicalized, while others lay the blame on the technology itself. In this paper, we explore the role played by technological design decisions in online self-radicalization in its myriad guises, encompassing extreme as well as more mundane forms. We begin by characterizing the phenomenon of technological seduction. Next, we distinguish between top-down seduction and bottom-up seduction. We then situate both forms of technological seduction within the theoretical model of dynamical systems theory. We conclude by articulating strategies for combating online self-radicalization.

A pdf is here.

A taxonomy of conscientious objection in healthcare

Gamble, N., & Saad, T. (2021). 

Clinical Ethics. 

https://doi.org/10.1177/1477750921994283

Abstract

Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.

Conclusion

The ethical analysis and framework we have presented demonstrate that conscience is intertwined with practical wisdom and is an intrinsic part of the work of healthcare professionals. The species of CO we have enumerated reveal that morality and values in healthcare are not only related to a few controversial ends, but to all ends and means in medicine, and the relationships between them.

The taxonomy we have presented will feasibly permit a more nuanced discussion of CO, where the issues surrounding and policy solutions for each species of CO can be discussed separately. Such a conversation

is an important task. After all, CO will not go away, even if specific belief systems rise or fall. CO exists

because humans have an innate awareness of the need to seek good and avoid evil, yet still arrive at disparate intellectual conclusions about what is right and wrong. Thus, if tolerant and amicable solutions

are to be developed for CO, conversations on CO in healthcare need to continue with a more integrated

understanding of practical reason and an awareness of broad involvement of conscience in medicine. We

hope our paper contributes to this end.

The info is here.

Get lucky: Situationism and circumstantial moral luck

Marcela Herdova & Stephen Kearns 

(2015) Philosophical Explorations, 18:3, 362-377

DOI: 10.1080/13869795.2015.1026923

Abstract

Situationism is, roughly, the thesis that normatively irrelevant environmental factors have a great impact on our behaviour without our being aware of this influence. Surprisingly, there has been little work done on the connection between situationism and moral luck. Given that it is often a matter of luck what situations we find ourselves in, and that we are greatly influenced by the circumstances we face, it seems also to be a matter of luck whether we are blameworthy or praiseworthy for our actions in those circumstances. We argue that such situationist moral luck, as a variety of circumstantial moral luck, exemplifies a distinct and interesting type of moral luck. Further, there is a case to be made that situationist moral luck is perhaps more worrying than some other well-discussed cases of (supposed) moral luck.

From the Conclusion

Those who insist on the significance of luck to our practices of moral assessment are on somewhat of a tightrope. If we consider agents who differ only in the external results of their actions, and who are faced with normatively similar circumstances, it is difficult to maintain that there is any major difference in the degree of such agents’ moral responsibility. If we consider agents that differ rather significantly, and face normatively distinct situations, then though luck may play a role in what normative circumstances they face, there is much to base a moral assessment on that is either under the agents’ control or distinctive of each agent and their respective responses to their normative circumstances (or both). The role luck plays in our assessments of such agents, then, is arguably small enough that it is unclear that any difference in moral assessment can be properly said to be due  to this luck (at least to an extent that should worry us or that is inconsiderable tension with our usual moral thinking).

A pdf is here.

Landmark research integrity survey finds questionable practices are surprisingly common

Jop De Vrieze

Science Magazine

Originally posted 7 Jul 21

More than half of Dutch scientists regularly engage in questionable research practices, such as hiding flaws in their research design or selectively citing literature, according to a new study. And one in 12 admitted to committing a more serious form of research misconduct within the past 3 years: the fabrication or falsification of research results.

This rate of 8% for outright fraud was more than double that reported in previous studies. Organizers of the Dutch National Survey on Research Integrity, the largest of its kind to date, took special precautions to guarantee the anonymity of respondents for these sensitive questions, says Gowri Gopalakrishna, the survey’s leader and an epidemiologist at Amsterdam University Medical Center (AUMC). “That method increases the honesty of the answers,” she says. “So we have good reason to believe that our outcome is closer to reality than that of previous studies.” The survey team published results on 6 July in two preprint articles, which also examine factors that contribute to research misconduct, on MetaArxiv.

When the survey began last year, organizers invited more than 60,000 researchers to take part—those working across all fields of research, both science and the humanities, at some 22 Dutch universities and research centers. However, many institutions refused to cooperate for fear of negative publicity, and responses fell short of expectations: Only about 6800 completed surveys were received. Still, that’s more responses than any previous research integrity survey, and the response rate at the participating universities was 21%—in line with previous surveys.

One of the preprints focuses on the prevalence of misbehavior—cases of fraud as well as a less severe category of “questionable research practices,” such as carelessly assessing the work of colleagues, poorly mentoring junior researchers, or selectively citing scientific literature. The other article focuses on responsible behavior; this includes correcting one’s own published errors, sharing research data, and “preregistering” experiments—posting hypotheses and protocols ahead of time to reduce the bias that can arise when these are released after data collection.

The info is here.

Understanding, explaining, and utilizing medical artificial intelligence

Cadario, R., Longoni, C. & Morewedge, C.K. 

Nat Hum Behav (2021). 

https://doi.org/10.1038/s41562-021-01146-0

Abstract

Medical artificial intelligence is cost-effective and scalable and often outperforms human providers, yet people are reluctant to use it. We show that resistance to the utilization of medical artificial intelligence is driven by both the subjective difficulty of understanding algorithms (the perception that they are a ‘black box’) and by an illusory subjective understanding of human medical decision-making. In five pre-registered experiments (1–3B: N = 2,699), we find that people exhibit an illusory understanding of human medical decision-making (study 1). This leads people to believe they better understand decisions made by human than algorithmic healthcare providers (studies 2A,B), which makes them more reluctant to utilize algorithmic than human providers (studies 3A,B). Fortunately, brief interventions that increase subjective understanding of algorithmic decision processes increase willingness to utilize algorithmic healthcare providers (studies 3A,B). A sixth study on Google Ads for an algorithmic skin cancer detection app finds that the effectiveness of such interventions generalizes to field settings (study 4: N = 14,013).

From the Discussion

Utilization of algorithmic-based healthcare services is becoming critical with the rise of telehealth service, the current surge in healthcare demand and long-term goals of providing affordable and high-quality healthcare in developed and developing nations. Our results yield practical insights for reducing reluctance to utilize medical AI. Because the technologies used in algorithmic-based medical applications are complex, providers tend to present AI provider decisions as a ‘black box’. Our results underscore the importance of recent policy recommendations to open this black box to patients and users. A simple one-page visual or sentence that explains the criteria or process used to make medical decisions increased acceptance of an algorithm-based skin cancer diagnostic tool, which could be easily adapted to other domains and procedures.

Given the complexity of the process by which medical AI makes decisions, firms now tend to emphasize the outcomes that algorithms produce in their marketing to consumers, which feature benefits such as accuracy, convenience and rapidity (performance), while providing few details about how algorithms work (process). Indeed, in an ancillary study examining the marketing of skin cancer smartphone applications (Supplementary Appendix 8), we find that performance-related keywords were used to describe 57–64% of the applications, whereas process-related keywords were used to describe 21% of the applications. Improving subjective understanding of how medical AI works may then not only provide beneficent insights for increasing consumer adoption but also for firms seeking to improve their positioning. Indeed, we find increased advertising efficacy for SkinVision, a skin cancer detection app, when advertising included language explaining how it works.

The research is here.