Living in an abortion ban state is bad for mental health

Keren Landman

vox.com

Originally posted 20 Feb 24

Here is an excerpt:

What they found was, frankly, predictable: Before the Court’s decision, anxiety and depression scores were already higher in trigger states — a population-wide average of 3.5 compared with 3.3 in non-trigger states. After the decision, that difference widened significantly, largely due to changes in the mental health of women 18 to 45, what the authors defined as childbearing age. Among this subgroup, anxiety and depression scores subtly ticked up in those living in trigger states (from 4.62 to 4.76) — and dropped in those living in non-trigger states (from 4.57 to 4.49). There was no similar effect in older women, nor in men.

These differences were small but statistically meaningful, especially since they sampled the entire population, not just women considering an abortion. Moreover, they were consistent across trigger states, whether their policies and political battles around abortion had been high- or low-profile. Even when the researchers omitted data from states with particularly severe restrictions on women’s reproductive health (looking at you, Texas), the results held up.

It’s notable that the different levels of mental distress across states after Roe was overturned weren’t just a consequence of worsened anxiety and depression in states with trigger bans. Also contributing: an improvement in these symptoms in states without these bans. We can’t tell from the study exactly why that is, but it seems plausible that women living in states that protect their right to access necessary health care simply feel some relief.

The research is here.

Here is the citation to the study:

Thornburg B, Kennedy-Hendricks A, Rosen JD, Eisenberg MD. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA. 2024;331(4):294–301. doi:10.1001/jama.2023.25599

Conclusions and Relevance  In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

How Did Polyamory Become So Popular?

Jennifer Wilson

The New Yorker

Originally posted 25 Dec 23

Here is an excerpt:

What are all these open couples, throuples, and polycules suddenly doing in the culture, besides one another? To some extent, art is catching up with life. Fifty-one per cent of adults younger than thirty told Pew Research, in 2023, that open marriage was “acceptable,” and twenty per cent of all Americans report experimenting with some form of non-monogamy. The extramarital “entanglements” of Will and Jada Pinkett Smith have been tabloid fodder for the past two years. (Pinkett Smith once clarified that their marriage is not “open”; rather, it is a “relationship of transparency.”) In 2020, the reality show “House Hunters,” on HGTV, saw a throuple trying to find their dream home—one with a triple-sink vanity. The same year, the city of Somerville, Massachusetts, allowed domestic partnerships to be made up of “two or more” people.

Some, like the sex therapist (and author of “Open Monogamy, A Guide to Co-Creating Your Ideal Relationship Agreement,” 2021), Tammy Nelson, have attributed the acceptance of a greater number of partners to pandemic-born domestic ennui; after being stuck with one person all day every day, the thinking goes, couples are ready to open up more than their pods. Nelson is part of a cohort of therapists, counsellors, and advice writers, including Esther Perel and the “Savage Love” columnist Dan Savage, who are encouraging married couples to think more flexibly about monogamy. Their advice has found an eager audience among the well-heeled attendees of the “ideas festival” circuit, featured in talks at Google, SXSW, and the Aspen Institute.

The new monogamy skepticism of the moneyed gets some screen time in the pandemic-era breakout hit “The White Lotus.” The show mocks the leisure class as they mope around five-star resorts in Hawaii and Sicily, stewing over love, money, and the impossibility, for people in their tax bracket, of separating the two. In the latest season, Ethan (Will Sharpe) and Harper (Aubrey Plaza) are an attractive young couple stuck in a sexless marriage—until, that is, they go on vacation with the monogamish Cameron (Theo James) and Daphne (Meghann Fahy). After Cameron and Harper have some unaccounted-for time together in a hotel room, Ethan tracks down an unbothered Daphne, lounging on the beach, to share his suspicion that something has happened between their spouses. Some momentary concern on Daphne’s face quickly morphs—in a devastatingly subtle performance by Fahy—into a sly smile. “A little mystery? It’s kinda sexy,” she assures Ethan, before luring him into a seaside cove. That night Ethan and Harper have sex, the wounds of their marriage having been healed by a little something on the side.

The info is here.

Here is my summary:

The article discusses the increasing portrayal and acceptance of non-monogamous relationships in contemporary culture, particularly in literature, cinema, and television. It notes that open relationships, throuples, and polyamorous arrangements are gaining prominence, reflecting changing societal attitudes. The author cites statistics and cultural examples, including a Gucci perfume ad and a plot twist in the TV series "Riverdale." The rise of non-monogamy is linked to a broader shift in societal norms, with some attributing it to pandemic-related ennui and a desire for more flexibility in relationships. The text also delves into the historical roots of polyamory, mentioning the Kerista movement and its adaptation to conservative times in the 1980s. The author concludes by expressing a desire for a more inclusive and equitable representation of polyamory, critiquing the limited perspective presented in a specific memoir discussed in the text.

Rising Suicide Rate Among Hispanics Worries Community Leaders

A. Miller and M. C. Work

KFF Health News

Originally posted 22 Jan 24

Here is an excerpt:

The suicide rate for Hispanic people in the United States has increased significantly over the past decade. The trend has community leaders worried: Even elementary school-aged Hispanic children have tried to harm themselves or expressed suicidal thoughts.

Community leaders and mental health researchers say the pandemic hit young Hispanics especially hard. Immigrant children are often expected to take more responsibility when their parents don’t speak English ― even if they themselves aren’t fluent. Many live in poorer households with some or all family members without legal residency. And cultural barriers and language may prevent many from seeking care in a mental health system that already has spotty access to services.

“Being able to talk about painful things in a language that you are comfortable with is a really specific type of healing,” said Alejandra Vargas, a bilingual Spanish program coordinator for the Suicide Prevention Center at Didi Hirsch Mental Health Services in Los Angeles.

“When we answer the calls in Spanish, you can hear that relief on the other end,” she said. “That, ‘Yes, they’re going to understand me.’”

The Centers for Disease Control and Prevention’s provisional data for 2022 shows a record high of nearly 50,000 suicide deaths for all racial and ethnic groups.

Grim statistics from KFF show that the rise in the suicide death rate has been more pronounced among communities of color: From 2011 to 2021, the suicide rate among Hispanics jumped from 5.7 per 100,000 people to 7.9 per 100,000, according to the data.

For Hispanic children 12 and younger, the rate increased 92.3% from 2010 to 2019, according to a study published in the Journal of Community Health.

The info is here.

Ethics Ratings of Nearly All Professions Down in U.S.

M. Brenan and J. M. Jones

gallup.com

Originally posted 22 Jan 24

Here is an excerpt:

New Lows for Five Professions; Three Others Tie Their Lows

Ethics ratings for five professions hit new lows this year, including members of Congress (6%), senators (8%), journalists (19%), clergy (32%) and pharmacists (55%).

Meanwhile, the ratings of bankers (19%), business executives (12%) and college teachers (42%) tie their previous low points. Bankers’ and business executives’ ratings were last this low in 2009, just after the Great Recession. College teachers have not been viewed this poorly since 1977.

College Graduates Tend to View Professions More Positively

About half of the 23 professions included in the 2023 survey show meaningful differences by education level, with college graduates giving a more positive honesty and ethics rating than non-college graduates in each case. Almost all of the 11 professions showing education differences are performed by people with a bachelor’s degree, if not a postgraduate education.

The largest education differences are seen in ratings of dentists and engineers, with roughly seven in 10 college graduates rating those professions’ honesty and ethical standards highly, compared with slightly more than half of non-graduates.

Ratings of psychiatrists, college teachers and pharmacists show nearly as large educational differences, ranging from 14 to 16 points, while doctors, nurses and veterinarians also show double-digit education gaps.

These educational differences have been consistent in prior years’ surveys.

Adults without a college degree rate lawyers’ honesty and ethics slightly better than college graduates in the latest survey, 18% to 13%, respectively. While this difference is not statistically significant, in prior years non-college graduates have rated lawyers more highly by significant margins.

Partisans’ Ratings of College Teachers Differ Most    

                

Republicans and Democrats have different views of professions, with Democrats tending to be more complimentary of workers’ honesty and ethical standards than Republicans are. In fact, police officers are the only profession with higher honesty and ethics ratings among Republicans and Republican-leaning independents (55%) than among Democrats and Democratic-leaning independents (37%).

The largest party differences are seen in evaluations of college teachers, with a 40-point gap (62% among Democrats/Democratic leaners and 22% among Republicans/Republican leaners). Partisans’ honesty and ethics ratings of psychiatrists, journalists and labor union leaders differ by 20 points or more, while there is a 19-point difference for medical doctors.

The info is here.

Understanding Liability Risk from Using Health Care Artificial Intelligence Tools

Mello, M. M., & Guha, N. (2024).

The New England journal of medicine, 390(3), 271–278. https://doi.org/10.1056/NEJMhle2308901

Optimism about the explosive potential of artificial intelligence (AI) to transform medicine is tempered by worry about what it may mean for the clinicians being "augmented." One question is especially problematic because it may chill adoption: when Al contributes to patient injury, who will be held responsible?

Some attorneys counsel health care organizations with dire warnings about liability1 and dauntingly long lists of legal concerns. Unfortunately, liability concern can lead to overly conservative decisions, including reluctance to try new things. Yet, older forms of clinical decision support provided important opportunities to prevent errors and malpractice claims. Given the slow progress in reducing diagnostic errors, not adopting new tools also has consequences and at some point may itself become malpractice. Liability uncertainty also affects Al developers' cost of capital and incentives to develop particular products, thereby influencing which Al innovations become available and at what price.

To help health care organizations and physicians weigh Al-related liability risk against the benefits of adoption, we examine the issues that courts have grappled with in cases involving software error and what makes them so challenging. Because the signals emerging from case law remain somewhat faint, we conducted further analysis of the aspects of Al tools that elevate or mitigate legal risk. Drawing on both analyses, we provide risk-management recommendations, focusing on the uses of Al in direct patient care with a "human in the loop" since the use of fully autonomous systems raises additional issues.

(cut)

The Awkward Adolescence of Software-Related Liability

Legal precedent regarding Al injuries is rare because Al models are new and few personal-injury claims result in written opinions. As this area of law matures, it will confront several challenges.

Challenges in Applying Tort Law Principles to Health Care Artificial Intelligence (AI).

Ordinarily, when a physician uses or recommends a product and an injury to the patient results, well-established rules help courts allocate liability among the physician, product maker, and patient. The liabilities of the physician and product maker are derived from different standards of care, but for both kinds of defendants, plaintiffs must show that the defendant owed them a duty, the defendant breached the applicable standard of care, and the breach caused their injury; plaintiffs must also rebut any suggestion that the injury was so unusual as to be outside the scope of liability.

The article is paywalled, which is not how this should work.

Pandemic priorities: the impact of the COVID 19 pandemic on ethical leadership in the healthcare profession

Musbahi, A., McCulla, A., & Ramsingh, J. (2022).

Leadership in health services (Bradford, England)

https://doi.org/10.1108/LHS-02-2022-0011

Abstract

Purpose: The COVID 19 pandemic has brought into sharp focus the importance of leadership and the ethics of health-care leadership. The purpose of this study is to investigate the impact of COVID 19 on ethical leadership principles using a validated quantitative survey of NHS leaders to compare pre- and post-pandemic ethical leadership principles.

Design/methodology/approach: This study involved a quantitative survey of NHS "leaders". Inclusion criteria included consultants and registrars leading clinical teams, or NHS managers, senior nurses and matrons. The survey was designed as a modification of the Ethical Leadership Questionnaire proposed by Langlois et al. (2013). A modification was made to ask questions from the questionnaire pertaining to before the pandemic and presently. This allowed a comparison of responses and measures of ethical leadership qualities before and after the pandemic. Twenty-three questions were on attitudes pre-pandemic, and 23 were post-pandemic.

Findings: A total of 79 responses were received. Responses were divided for analysis into those related to an ethics of care dimension, those related to ethics of justice and those related to the ethics of critique. This study has found significant changes in attitudes of health-care leaders with regards to the ethics of critique. Leaders were more likely post-pandemic to speak out against injustice and unfair practices. Leaders were also more concerned with matters of human dignity as well as understanding how some groups may be privileged. Other ethical principles showed no statistical difference.

Originality/value: This paper highlights the changes the COVID-19 pandemic has had on leaders' attitudes to ethics.

The article is paywalled here.

Here are some thoughts:

Key findings suggest a shift in leaders' attitudes towards the "ethics of critique." Leaders became more vocal against injustice and unfair practices, demonstrating increased concern for human dignity and understanding of privilege dynamics. However, no significant changes were observed in other ethical dimensions like "ethics of care" or "ethics of justice."

While the pandemic didn't demonstrably alter overall views on ethical leadership, it did heighten awareness of social context and its influence on good leadership. Leaders prioritized staff well-being and addressed social and workplace inequalities, aligning with movements like Black Lives Matter and tackling issues like PPE shortages and staffing crises.

Overall, the study highlights the pandemic's influence on healthcare leadership, particularly in fostering a more critical and socially conscious approach to ethical decision-making. Leaders emerged more likely to challenge injustices and advocate for fairness, while remaining committed to core ethical principles of care and justice.

Amazon AGI Team Say Their AI is Showing "Emergent Properties"

Noor Al-Sibai

Futurism.com

Originally posted 15 Feb 24

A new Amazon AI model, according to the researchers who built it, is exhibiting language abilities that it wasn't trained on.

In a not-yet-peer-reviewed academic paper, the team at Amazon AGI — which stands for "artificial general intelligence," or human-level AI — say their large language model (LLM) is exhibiting "state-of-the-art naturalness" at conversational text. Per the examples shared in the paper, the model does seem sophisticated.

As the paper indicates, the model was able to come up with all sorts of sentences that, according to criteria crafted with the help of an "expert linguist," showed it was making the types of language leaps that are natural in human language learners but have been difficult to obtain in AI.

Named "Big Adaptive Streamable TTS with Emergent abilities" or BASE TTS, the initial model was trained on 100,000 hours of "public domain speech data," 90 percent in English, to teach it how Americans talk. To test out how large models would need to be to show "emergent abilities," or abilities they were not trained on, the Amazon AGI team trained two smaller models, one on 1,000 hours of speech data and another on 10,000, to see which of the three — if any — exhibited the type of language naturalness they were looking for.

The info is here.

My overall conclusion from the paper linked in the article:

BASE TTS (Text To Speech) represents a significant leap forward in TTS technology, offering superior naturalness, efficiency, and potential for real-world applications like voicing LLM outputs. While limitations exist, the research paves the way for future advancements in multilingual, data-efficient, and context-aware TTS models.

What Stops People From Standing Up for What’s Right?

Julie Sasse

Greater Good

Originally published 17 Jan 24

Here is an excerpt:

How can we foster moral courage?

Every person can try to become more morally courageous. However, it does not have to be a solitary effort. Instead, institutions such as schools, companies, or social media platforms play a significant role. So, what are concrete recommendations to foster moral courage?

• Establish and strengthen social and moral norms: With a solid understanding of what we consider right and wrong, it becomes easier to detect wrongdoings. Institutions can facilitate this process by identifying and modeling fundamental values. For example, norms and values expressed by teachers can be important points of reference for children and young adults.
• Overcome uncertainty: If it is unclear whether someone’s behavior is wrong, witnesses should feel comfortable to inquire, for example, by asking other bystanders how they judge the situation or a potential victim whether they are all right.
• Contextualize anger: In the face of wrongdoings, anger should not be suppressed since it can provide motivational fuel for intervention. Conversely, if someone expresses anger, it should not be diminished as irrational but considered a response to something unjust. 
• Provide and advertise reporting systems: By providing reporting systems, institutions relieve witnesses from the burden of selecting and evaluating individual means of intervention and reduce the need for direct confrontation.
• Show social support: If witnesses directly confront a perpetrator, others should be motivated to support them to reduce risks.

We see that there are several ways to make moral courage less difficult, but they do require effort from individuals and institutions. Why is that effort worth it? Because if more individuals are willing and able to show moral courage, more wrongdoings would be addressed and rectified—and that could help us to become a more responsible and just society.

The info is here.

Main points:

• Moral courage is the willingness to stand up for what's right despite potential risks.
• It's rare because of various factors like complexity of the internal process, situational barriers, and difficulty seeing the long-term benefits.
• Key stages involve noticing a wrongdoing, interpreting it as wrong, feeling responsible, believing in your ability to intervene, and accepting potential risks.
• Personality traits and situational factors influence these stages.

Citing Harms, Momentum Grows to Remove Race From Clinical Algorithms

B. Kuehn

JAMA

Published Online: January 17, 2024.

doi:10.1001/jama.2023.25530

Here is an excerpt:

The roots of the false idea that race is a biological construct can be traced to efforts to draw distinctions between Black and White people to justify slavery, the CMSS report notes. For example, the third US president, Thomas Jefferson, claimed that Black people had less kidney output, more heat tolerance, and poorer lung function than White individuals. Louisiana physician Samuel Cartwright, MD, subsequently rationalized hard labor as a way for slaves to fortify their lungs. Over time, the report explains, the medical literature echoed some of those ideas, which have been used in ways that cause harm.

“It is mind-blowing in some ways how deeply embedded in history some of this misinformation is,” Burstin said.

Renewed recognition of these harmful legacies and growing evidence of the potential harm caused by structural racism, bias, and discrimination in medicine have led to reconsideration of the use of race in clinical algorithms. The reckoning with racial injustice sparked by the May 2020 murder of George Floyd helped accelerate this work. A few weeks after Floyd’s death, an editorial in the New England Journal of Medicine recommended reconsidering race in 13 clinical algorithms, echoing a growing chorus of medical students and physicians arguing for change.

Congress also got involved. As a Robert Wood Johnson Foundation Health Policy Fellow, Michelle Morse, MD, MPH, raised concerns about the use of race in clinical algorithms to US Rep Richard Neal (D, MA), then chairman of the House Ways and Means Committee. Neal in September 2020 sent letters to several medical societies asking them to assess racial bias and a year later he and his colleagues issued a report on the misuse of race in clinical decision-making tools.

“We need to have more humility in medicine about the ways in which our history as a discipline has actually held back health equity and racial justice,” Morse said in an interview. “The issue of racism and clinical algorithms is one really tangible example of that.”

The info is here.

My summary: There's increasing worry that using race in clinical algorithms can be harmful and perpetuate racial disparities in healthcare. This concern stems from a recognition of the historical harms of racism in medicine and growing evidence of bias in algorithms.

A review commissioned by the Agency for Healthcare Research and Quality (AHRQ) found that using race in algorithms can exacerbate health disparities and reinforce the false idea that race is a biological factor.

Several medical organizations and experts have called for reevaluating the use of race in clinical algorithms. Some argue that race should be removed altogether, while others advocate for using it only in specific cases where it can be clearly shown to improve outcomes without causing harm.