A digital nightmare: When fitness bands become student-tracking devices [News release]

From the 25 May 2015 University of Queensland news release

A “nightmarish” vision of a future in which technology makes physical education more boring, judgmental and narrow is driving a new study by a University of Queensland academic.

Associate Professor Michael Gard from the School of Human Movement and Nutrition Sciences has begun a three-year research project on the digitisation of school health and physical education.

The project stems from the assumption that developments in digital technology present exciting educational opportunities but carry a new set of philosophical, educational and ethical questions and dilemmas.

“Will we leverage the power of digital technology to expand students’ minds and open up choices about how to live, or will we use it to monitor students’ behaviour and tell them how to live?” Dr Gard said.

“For example, much of the health-related technology that we are seeing involves asking children to count the calories they consume or expend when they are exercising. Is this this what we want students to be doing at school?

“There is a lot of money to be made from digitising school health and physical education and, make no mistake, companies are already vigorously marketing all kinds of health and fitness technologies to schools.

“Then you have the whole ‘big data’ concern about how your child’s records are used.”

…

 

“Then think of a perfect storm, where performance pay for health and physical education teachers is linked to children losing weight, and you introduce some very tricky ethical situations. Once again, some American states are moving in this direction.”

The study will also investigate how schools use digital technology to measure students, such as their BMI (body mass index), and what becomes of the data once collected.

Anticipating temptation may reduce unethical behavior, research finds

Anticipating temptation may reduce unethical behavior, research finds.

From the 22 May 2015 EurekAlert

Why do good people do bad things? It’s a question that has been pondered for centuries, and new research published by the Society for Personality and Social Psychology may offer some insights about when people succumb to versus resist ethical temptations.

“People often think that bad people do bad things and good people do good things, and that unethical behavior just comes down to character,” says lead research author Oliver Sheldon, PhD. “But most people behave dishonestly sometimes, and frequently, this may have more to do with the situation and how people view their own unethical behavior than character, per se.”

In a series of experiments, participants who anticipated a temptation to act unethically were less likely to then behave unethically, relative to those who did not. These participants also were less likely to endorse unethical behavior that offered short-term benefits, such as stealing office supplies or illegally downloading copyrighted material. The study was published online in the Personality and Social Psychology Bulletin on May 22, 2015.

“Self-control, or a lack thereof, may be one factor which explains why good people occasionally do bad things,” says Sheldon, an assistant professor of organizational behavior at Rutgers University.

..

Anticipating temptation may only help, however, if people identify an unethical act as having the potential to jeopardize their self-image, integrity, or reputation.

…

Participants who were encouraged to anticipate temptation and who thought their behavior was consistent with their future self, were honest

…

People also may be more likely to engage in unethical behavior if they believe the act is an isolated incident.

…

“Unethical behavior may not be experienced as something that needs to be resisted if people think it’s socially acceptable or does not reflect on their moral self-image,” Sheldon says. “People often compartmentalize their experiences of temptation, making it much easier for them to rationalize the behavior. They might say, ‘Just because I took office supplies home for personal use one time, that doesn’t mean I’m a thief.'”

If people want to avoid unethical behavior, it may help to anticipate situations where they will be tempted and consider how acting upon such temptation fits with their long-term goals or beliefs about their own morality. “You may not be concerned about getting caught or about your reputation if people found out, but you might be concerned about your own ethical self-image,” Sheldon says. “Keeping such considerations in mind as one enters into potentially tempting situations can help people resist the temptation to behave unethically.”

The same suggestions may apply for employers, Sheldon says. For example, a manager could email employees before a work trip to warn them against the temptation to inflate travel expenses. The reminder about upcoming temptation might help protect the company’s bottom line, especially if employees view the temptation to inflate travel expenses as something they will encounter repeatedly in the future.

Related articles

• Here’s Why Good People Occasionally Do Bad Things: Lack of Self-Control
• The week in security: Hackers hack the hackers as Hacking Team falls
• The moral foundation of liberals and conservatives – not so different after all?
• Lonely people are not just awkward: Loners ‘crack under the pressure’ of social interaction
• A Deeper Look at the Evil Within
• Researchers Say Women Less Likely than Men to Kill Hitler, if they Traveled Back in Time
• Death Anxiety: Emergency Nurses May Be More Prone To This Health Issue

[Research article]Morality Rebooted: Exploring Simple Fixes to Our Moral Bugs

From the abstract

Morality Rebooted: Exploring Simple Fixes to Our Moral Bugs

Ting Zhang ,Harvard Business School

Francesca Gino ,Harvard University – Harvard Business School

Max H. Bazerman ,Harvard Business School – Negotiations, Organizations and Markets Unit
April 21, 2014

Harvard Business School NOM Unit Working Paper No. 14-105

Abstract:      

Ethics research developed partly in response to calls from organizations to understand and solve unethical behavior. Departing from prior work that has mainly focused on examining the antecedents and consequences of dishonesty, we examine two approaches to mitigating unethical behavior: (1) values-oriented approaches that broadly appeal to individuals’ preferences to be more moral, and (2) structure-oriented approaches that redesign specific incentives, tasks, and decisions to reduce temptations to cheat in the environment. This paper explores how these approaches can change behavior. We argue that integrating both approaches while avoiding incompatible strategies can reduce the risk of adverse effects that arise from taking a single approach.

Ethics: A Patient’s Right to Not Know

Ethics: A Patient’s Right to Not Know.

Excerpt

Writing in Science, the chair of the Presidential Commission for the Study of Bioethical Issues notes it is increasingly common for physicians and medical researchers to discover a disease that was not the original target of a medical test or screening.

Amy Guttman Ph.D. notes these surprise clinical test results are called incidental and secondary findings. Guttman explains the surprise discovery of an unexpected illness from screening and similar tests is called an ‘incidental’ finding. Guttman adds when clinicians deliberately seek to discover a second or third disease in addition to the primary target, these results are called ‘secondary’ findings.

Guttman, who is the president of the University of Pennsylvania, writes (and we quote): ‘Improved technologies are making incidental and secondary findings increasingly common. They are becoming a growing certainty in clinical practice as well as in the distinct contexts of research and direct-to-consumer testing’ (end of quote). For example, Guttman notes an array of unexpected clinical findings may be generated by new CT scans intended to detect lung cancer in heavy smokers. The increased screening will occur because of recent recommendations from the U.S. Preventive Services Task Force, which we discussed in last week’s podcast.

Guttman writes before CT scans or other medical tests, clinicians should alert patients about the possibility of surprise findings regardless whether screening deliberately seeks (or accidentally finds) new, unexpected illnesses.

http://www.jakebouma.com/i-have-hodgkin-lymphoma/

Guttman notes while some persons will ask a physician to tell them about whatever clinical tests discover, some patients do not want to learn about incidental or secondary findings.

As a result, the Presidential Bioethics Commission recommends physicians and medical practitioners need to know a patient’s health priorities and tolerance to manage surprising results prior to clinical testing. Guttman writes (and we quote) ‘A patient who does not wish to learn about information related to the primary purpose of the test should not undergo the test. If a patient wishes to opt out of receiving incidental or secondary findings that are clinically significant and actionable, then clinicians should exercise their discretion whether to proceed with testing’ (end of quote).

Guttman notes health care providers should explain both the risks and rewards of finding unexpected illnesses that can occur from a new generation of sophisticated clinical tests, such as human genome screenings. While false positive findings are among the risks, Guttman explains the rewards include the detection of diseases and illness that could be clinically actionable.

In terms of biomedical ethics, Guttman concludes (and we quote):’ In keeping with shared decision-making, clinicians live up to their highest calling when they discuss how they will handle incidental findings with their patients’ (end of quote). While the Presidential Bioethics Commission provides more specific recommendations in their report, their overall intent is to improve patient-provider disclosure and communication as well as help patients anticipate the possibility of unexpected findings from routine testing.

The Commission’s report is available at bioethics.gov.

Meanwhile, a link to a website that explains some of the ethical issues associated with patient and provider health decision making (from Beth Israel Medical Center) is available in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.

Similarly, a link to a website that explains some of the ethical issues associated with patient and provider treatment decisions (also from Beth Israel Medical Center) can be found in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.

MedlinePlus.gov’s medical ethics health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s medical ethics health topic page type ‘medical ethics’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘medical ethics (National Library of Medicine).’ MedlinePlus.gov additionally contains a health topic page on talking with your doctor, which provides tips to enhance provider and patient communication.

Related articles

• Bioethics Commission on incidental findings: Anticipate and communicate
• Panel Discussions – Bioethics at Huntington Hospital and Neurological Disorders with PALAC
• Improving the quality of clinical ethics consultants

[Journal article] How Basic Scientists Help the Pharmaceutical Industry Market Drugs

Excerpt from the December 2013 PLoS article by Adriane Fugh-Berman 

In the 1970s, a Baltimore city senator who also owned a tavern backed legislation that helped his business. Accused of having a conflict of interest, Joseph J. Staszak, responded, “What conflict of interest? How does this conflict with my interest?” [1].

According to the Institute of Medicine, a conflict of interest is “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary influence” [2]. More simply, conflicts of interest may be seen as circumstances in which “individuals’ professional responsibilities diverge from their personal interests (or when different professional responsibilities clash)” [3].

In biomedicine, discourse on conflicts of interest (also called competing interests) has focused on relationships between industry and physicians or clinical researchers. However, basic scientists are not immune to industry influence on research and publications, and may be important to industry in the production and dissemination of marketing messages.

Depending on Industry

In 2007, industry was the largest funder of biomedical research, paying for nearly twice as much research (58%) as the federal government (33%) [4]. Most of this funding goes to clinical research; the share of spending by pharmaceutical and device industry on preclinical research has decreased from about half (55%) in 1998 to a quarter (25%) in 2010 [5]. A 2007 survey of 3,080 academic life science researchers found that half (53%) have some form of relationship with industry [6]. Among the 1,663 research faculty at academic medical centers, 42% of basic scientists had a relationship with industry. This number was similar to health services researchers/clinical epidemiologists (40%), but less than clinical researchers (67%) translational researchers (61%), or “multimodal” researchers (71%) [7]. At the 50 universities that received the most NIH research funding, 43% of 2,167 life science researchers reported receiving a research-related gift in the late 1990s [8]. Gifts included biomaterials (24% of respondents), discretionary funds (15%), equipment (11%), travel funds to professional meetings (11%), student support (9%), and other (3%).

Researchers were aware that something was expected in return for the gift. Sponsor expectations that the gift be used for its intended purpose and not be re-gifted, and that the sponsor be acknowledged in publications, are certainly reasonable. Disturbingly, however, about a third (32%) of gift recipients reported that the funder wanted prepublication review of any articles or reports stemming from the use of the gift. This expectation was higher for gifts of biomaterials: 40% of respondents reported that the firm wanted to receive prepublication review of articles or reports. Also, 44% of firms wanted assurances that the biomaterial was not to be used for applications that competed with company products [8].

Industry Funding Affects Results

In clinical research, investigators who receive industry funding are more likely to publish results that favor a sponsor’s marketing goals than are investigators who do not receive industry funding. The Cochrane Collaboration, renowned for creating and publishing high-quality systematic reviews, analyzed 48 clinical studies, systematic reviews, and meta-analyses that compared results from studies of drugs or medical devices based on sponsorship. This systematic review found that industry-sponsored studies, compared to non-industry-sponsored studies, were more likely to report favorable efficacy results for drugs or medical devices; less likely to find harms; and more likely to conclude that a therapy was beneficial [9].

…

Selective Publication

Selective presentations and publications are important tactics for industry. Industry relies on abstracts and posters to convey marketing messages at scientific meetings, because abstracts and posters are usually not peer-reviewed and can be easily altered up to the time of presentation. Posters and abstracts are often used for preclinical studies, case reports, or preliminary results of clinical trials. Promising preliminary results might be presented as a poster, and the results may be publicized, but if the final results of the study do not support commercial goals, the full study may never be published – or may be buried in an obscure, low-impact journal. In either case, scientists may have a positive impression of a therapy from a poster, and never learn that the therapy failed to show efficacy in the final study.

…

Perhaps because negative outcomes from industry-funded studies are less likely to be submitted for publication, industry-funded clinical trials overall are less likely to be published. An analysis of 546 drug trials listed in ClinicalTrials.gov found that within two years of study completion, about a third of studies that received full (32%) or partial (39%) industry support were published. In contrast, more than half (54%) of trials funded by government, and 56% of trials funded entirely through nonprofit/nonfederal funds, were published [19].

The majority of meeting abstracts and posters are never published. Posters and abstracts with positive results are far more likely to be published than negative studies [14],[15].

..

Once a drug is on the market, it can be prescribed “off-label” – that is, for any condition other than that for which the drug was approved. Although it is legal for physicians and other prescribers to prescribe a drug off-label, it is illegal for pharmaceutical companies to promote drugs off-label. Off-label use is common, accounting for about one in five prescriptions [23]. It is unknown how much off-label use is due to promotion.

Pharmaceutical companies use paid speakers, consultants, and researchers to promote off-label use [24].

,,,

Companies have paid billions of dollars in fines for off-label promotion, often using company-generated research, company-paid speakers, and ghostwritten articles to imply clinical benefits in the absence of clinical trials (or the presence of negative trials); fines have also been imposed for suppressing risks or misleading clinicians about risks [34].

…

Read the entire article here

Related articles

• How basic scientists help the pharmaceutical industry market drugs (medicalnewstoday.com)
• ‘All Trials’: because no test should go unheralded (nsnbc.me)
• How Manipulated Clinical Evidence Could Distort Guidelines – the Case of Statins for Primary Prevention (hcrenewal.blogspot.com)
• UAlberta researchers uncover why combination drug treatment ineffective in cancer clinical trials (eurekalert.org)
• Drug Safety: Conditions bordering Corruption threaten Public Health (nsnbc.me)
• Why combination drug treatment ineffective in cancer clinical trials (medicalnewstoday.com)
• Transparency in cancer trials is vital (alltrials.net)
• Monitoring the healing resources by clinical research (socialdigitalbuzz.wordpress.com)

 

Ethics Abandoned: Medical Professionalism and Detainee Abuse in the ‘War on Terror’

From the summary at Full Text Reports (November 6, 2013)

Source: Institute on Medicine as a Profession and Open Society Institute (via Harvard Law School)

the task Force has determined that actions taken by the U.s. government immediately following 9/11 included three key elements affecting the role of health professionals in detention centers:

1. The declaration that as part of a “war on terror,” individuals captured and detained in Afghanistan, Pakistan, and elsewhere were “unlawful combatants” who did not qualify as prisoners of war under the geneva conventions. Additionally, the U.S. Department of Justice approved of interrogation methods recognized domestically and internationally as constituting torture or cruel, inhuman, or degrading treatment.

2. The DoD and CIA’s development of internal mechanisms to direct the participation of military and intelligence-agency physicians and psychologists in abusive interrogation and breaking of hunger strikes. Although the involvement of health professionals in human rights violations against detainees progressed differently in the military and the CIA, both facilitated that involvement in similar ways, including undermining health professionals’ allegiances to established principles of professional ethics and conduct through reinterpretation of those principles.
[my emphasis – Janice]

3. The secrecy surrounding detention policies that prevailed until 2004– 2005, when leaked documents began to reveal those policies. secrecy allowed the unlawful and unethical interrogation and mistreatment of detainees to proceed unfettered by established ethical principles and standards of conduct as well as societal, professional, and nongovernmental commentary and legal review.

These key elements, as well as the task Force’s recommendations for remediating the participation of health professionals in detainee torture or cruel, inhuman, or degrading treatment, are summarized below and addressed in detail in the body of this report.

Related articles

• New report condemns US medical professionals’ role in torture (counterinformation.wordpress.com)

• Doctors’ role in enhanced military interrogation ‘clearly violates’ ethics (PBS News Hour)

[Press release] Ethical research with minorities

Johns Hopkins press release as posted in the 5 November 2013 EurekAlert

PUBLIC RELEASE DATE:

5-Nov-2013

Contact: Leah Ramsay
lramsay@jhu.edu
202-642-9640
Johns Hopkins Medicine

Ethical research with minorities

Johns Hopkins bioethicist Nancy Kass is a guest editor of the AJPH special issue taking a comprehensive look at the current ethical landscape of human subjects research with minority populations

Remarkable improvements in the quality of life, prevention and treatment of disease have been made possible through advancements in biomedical research, including clinical trials involving human subjects. Future progress will depend in large measure on the inclusion of women and racial and ethnic minority populations into the research enterprise. Unfortunately, research abuses in the past have contributed to fear and mistrust among these populations resulting in regulatory measures designed to protect them due to their real or perceived “vulnerability.”

Increasingly groups seen as vulnerable are demanding access to the benefits of research and investigators are making progress in successful inclusion of women and minorities. This question of vulnerability is just one of many ethically relevant concepts raised in the current theme issue of the American Journal of Public Health, titled “The Ethics of Human Subjects Research on Minorities”.

“While there is growing attention to the participation of minority populations in research, there has been far less attention on the ethical issues raised through research recruitment, enrollment and engagement; our goal was to shine a spotlight on those issues in particular,” says Nancy E. Kass, ScD, one of three guest editors of the issue and the Deputy Director for Public Health at the Johns Hopkins Berman Institute of Bioethics.

The theme issue opens with an editorial by Kass and her co-guest editors Sandra C. Quinn, PhD, and Stephen B. Thomas, PhD, of the Maryland Center for Health Equity (M-CHE) at the University of Maryland School of Public Health. In their editorial, “Building Trust for Engagement of Minorities in Human Subjects Research: Is the Glass Half Full, Half Empty or the Wrong Size?” The editors contextualize the history of human subjects protections for “vulnerable persons,” recognizing that the protections themselves, while critically important and very successful, may also have limited the benefits of research among the populations that were “protected”. They discuss the progress we’ve made, the challenges still to be tackled, and propose a shift in the way researchers approach minority communities.

Other topics explored in the issue include recruitment of minority populations, community engagement, and training of researchers and health professionals in ethics and working with minority populations. Articles in the volume focus on specific populations including Native American and Alaskan Native populations, persons with disabilities, populations at risk of contracting HIV, and racial and ethnic minority populations.

The theme issue is one of the scholarly products made possible by the National Bioethics Research Infrastructure Initiative grant from the NIH-NIMHD, “Building Trust Between Minorities and Researchers ” awarded to the University of Maryland Center for Health Equity. The issue assembles a collection of peer-reviewed papers that explore the complexities involved in the ethical inclusion of minority populations in research and the challenges facing the nation in having a research enterprise that is both protective and inclusive of vulnerable groups. Additionally, contemporary research operates in the long shadow cast by the abuse of human subjects in research, Kass says.

Drs. Quinn, Kass, and Thomas are uniquely suited to guest editing this theme issue. Kass holds a joint appointment in Johns Hopkins’ Berman Institute of Bioethics and Bloomberg School of Public Health as the Phoebe R. Berman Professor of Bioethics and Public Health; she is a globally recognized public health expert and has served on international and national ethics committees, in addition to leading the Johns Hopkins-Fogarty African Bioethics Training Program for the last 13 years.

Quinn has extensive experience investigating the impact of disasters on preparedness of minority communities and the willingness of these groups to accept seasonal flu and other vaccines. Thomas is Professor and Founding Director of the Maryland Center for Health Equity at the University of Maryland School of Public Health and a recognized national expert on community engaged research. His work with Quinn on the legacy of the US Public Health Service Syphilis Study done at Tuskegee contributed to the 1997 Presidential Apology to survivors. Together Thomas and Quinn are principal investigators of the Building Trust project at M-CHE.

According to Dr. Thomas, “It is impressive how several of the articles call for the re-imagination of human subjects protections for vulnerable populations and a reengineering of the research enterprise to elevate the ‘community’ to be as important as the ‘individual’ when it comes to improving the informed consent process” he said.

 

###

The full theme issue is available online now at http://ajph.aphapublications.org/

The print version will be available December 2013.

Funding for the theme issue was provided the by Award Number 7RC2MD004766 (Quinn & Thomas, Principal Investigators) from the National Institute on Minority Health and Health Disparities (NIMHD) and the Office of the Director, National Institutes of Health (NIH).

 

Related articles

• PEBS Neuroethics Roundup (JHU) (kolber.typepad.com)
• Minorities Underrepresented in Federal Regulations on Human Subject Research (hofstrabioethics.wordpress.com)

 

Experiments in Collaboration: Interdisciplinary Graduate Education in Science and Justice

This grant caught my eye at least partly because I am now reading a rather dense biography on Robert Oppenheimer.
Oppenheimer was the director of the  Manhattan Project, the program that developed the first nuclear weapon during World War II. However, he later became the chairman of the General Advisory Committee of the Atomic Energy Commission,which later opposed the development of the hydrogen bomb. And he went on to support international control of atomic energy.

The Manhattan project, and the larger government-scientific community failed to look at the long term consequences of developing atomic weapons.

So it is refreshing to see, hopefully not too late !, that our government is willing to see the long term consequences of science and technology through grants as this.

From the article at PLos One

Over the past two decades, policy changes at the national level have created an increased focus on science-society relations. An example in the United States has been a subtle but significant shift in the foundational principles of the National Science Foundation (NSF): rather than assume societal benefits directly flow from support of science and engineering, the NSF now explicitly seeks to create knowledge that benefits society [1]–[4]. To achieve this goal, the agency moved in 1997 to adopt the Broader Impacts Criterion (BIC) to review grant proposals [5],[6]. Similarly, the 2007 America COMPETES Act increased ethics education requirements for graduate students and postdoctoral fellows without specifying content[7]–[10]. While these policy changes require scientists and engineers to practice science and engineering in new ways that engage “the public” and benefit “society,” few institutions provide physical spaces for cross-disciplinary contact and intellectual space for figuring out how practically to achieve these ends [10]–[13].

…

SJTP is a graduate-level research and education program that trains science and engineering students alongside students of social science, arts, and humanities to respond to the ethical and social justice questions that arise in their research. Rather than treating justice as a concern to be tacked onto an already formed research project, SJTP graduate fellows are provided with fellowship funding and faculty mentorship that supports them to explore questions of ethics and justice as they arise in their research.

…

The space, funding, and institutional recognition of the program give fellows the opportunity to reorient their research questions, methodologies, and goals around questions of science and justice.

…

 

Some related bioethics resources

• Bioethics Resources on the Web (NIH)
• Bioethics Forum (Hastings)
• BioethicsNet

Related articles

• Why Future Business Leaders Need Philosophy (bigthink.com)
• CATO: against all public funding of science (motls.blogspot.com)
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Introducing a three-part series on medical journal ghostwriting

Gary Schwitzer, at HealthNewsReview.org, presents a three part series on medical journal ghostwriting.

Good overview on how to spot ghostwriting and two examples of how ghostwriting may introduce conflicts of interest and skewed results.

 

Medical devices and shared decision-making

Medical devices and shared decision-making.

From the 18 October 2012 article at HealthNewsReview.org

The journal Arthritis Care & Research has accepted for future publication – and posted online (for subscribers) – an unedited paper, “Preceding the Procedure:  Medical Devices and Shared Decision-Making.”  The paper builds on a hypothetical example of a man in his 50s with hip arthritis who is facing a decision about total hip replacement.  Excerpts:

“(The surgeon – Dr. Jones) reviews the procedure with him and confirms that he understands his options. Then (the patient – Mr.Thomas) signs the surgical consent form. This discussion appears to include all the elements of informed consent, but several ethical questions linger beneath the surface. Dr. Jones discussed the risks and benefits of total hip replacement in some detail to help Mr. Thomas decide whether or not to have surgery, but should Mr. Thomas also have participated in the decision about the specific implant to be used?…

This article teases out the ethical issues underlying the choice of a medical device for surgical procedures, using the example of total joint arthroplasty to illustrate the interactions between surgeons and their patients. We highlight shortcomings in the current regulatory process that result in a thin evidence base on which to anchor these technical decisions, and we note the potential for decisions to be influenced by the surgeon’s personal beliefs and possible conflicts of interest. We suggest that the informed consent process could be enriched with a greater focus on shared decision-making. This would include discussing the choice of implant and other technical decisions that may affect the outcome of the procedure, in addition to disclosing any relevant financial relationships. We note the challenge of providing patients with easily digestible information that helps them make decisions consistent with their own values. …

 

…

urgeons reporting “that that they typically face few institutional constraints on their choice of implants, so many are able to decide for themselves when they wish to begin using newer models.”

Photo credit: dpstyles™ via Flickr

And it provides background for consideration of conflicts of interest:  “The choice of implant is complicated further by the possibility for conflicts of interest stemming from the consulting fees that some orthopedists receive from device manufacturers. In 2007, the five largest manufacturers made payments to approximately 4% of the 25,000 registeredorthopedic surgeons in the United States. These payments typically involve surgeons in high volume practices and academic settings. Orthopedists who receive industry support express, on average, a greater sense of shared goals and priorities with their vendors and sales representatives than surgeons who don’t.”

Related articles

• Shared decision making leads to a better patient experience and higher levels of patient satisfaction (introcommblog.wordpress.com)
• What is the Impact on Shared Decision Making of the Daily Tsunami of Health News? (engagingthepatient.com)
• Addressing Health Literacy: A Variation of Perspectives (engagingthepatient.com)

 

Why Do Good People Sometimes Do Bad Things?: 52 Reflections on Ethics at Wor

 

From the Full Text Reports abstract of August 25, 2012

 Why Do Good People Sometimes Do Bad Things?: 52 Reflections on Ethics at Work

M. Kaptein , Erasmus University Rotterdam (EUR) – Rotterdam School of Management (RSM)

Source: Social Science Research Network

Why do good people sometimes do bad things in their work? This important question for the management of the ethics and integrity of an organization is addressed in this book. Drawing on social-psychological experiments, a model of 7 cultural factors is presented.

Related articles

• Ethical Quandary at Work? Here’s How to Handle It (empwaynek.wordpress.com)

 

Should Your Boss Encourage You to Take Drugs?

And if so, is the workplace still drug free??? And if an employee would prefer not to follow advice on using a drug??

From the 6 June 2012 article at The Health Care Blog

A top executive I know recently decided to takeInderal before making high-pressure/high-anxiety presentations. The impact was immediate. She felt more relaxed, confident and effective. Her people agreed.

Would she encourage a comparably anxious subordinate to take the drug? No. But if that employee’s anxiety really undermined his or her effectiveness, she’d share her story and make them aware of the Inderal option. She certainly wouldn’t disapprove of an employee seeking prescription help to become more productive.

No one in America thinks twice anymore if a colleague takes Prozac. (Roughly 10% of workers in Europe and the U.K. use antidepressants, as well). Caffeine has clearly become the (legal) stimulant of business choice and Starbucks its most profitable global pusher (two shots of espresso, please).

Increasingly, prescription ADHD drugs like Adderall, dedicated to improving attention deficits, are finding their way into gray market use by students looking for a cognitive edge. When one looks at existing and in-the-pipeline drugs for Alzheimer’s and other neurophysiological therapies for aging OECD populations with retirements delayed, the odds are that far more employees are going to be taking more drugs to get more work done better….

Related articles

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• FDA Warns of Fake Version of ADHD Drug Adderall (news.health.com)
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Trying to keep up with health care ethics (mis)adventures

From http://www.jsonline.com/features/health/drug-company-money-and-the-rise-of-opiod-usage-139609893.html

The 14 May 2012 HealthNewsReview.org post highlights three biomedical ethics items

• Journalists Bag a Big One: The American Pain Foundation (Reporting on Health, May 14, 2012)

“…The American Pain Foundation – an industry funded promoter of painkillers masquerading as a patient advocacy organization – closed its doors last week after it became the target of a U.S. Senate panel inquiry.The action by the U.S. Senate Finance Committee and the surprisingly quick collapse of the foundation were prompted by two journalistic investigations:The first was Charles Ornstein’s and Tracy Weber’s Dollars for Doctors series for ProPublica. In The Champion of Painkillers, which ran in December in The Washington Post, they describe how aggressive the American Pain Foundation has been in promoting opioids:..

..The other major journalistic investigation to draw the Senate’s attention was by John Fauber at the Milwaukee Journal Sentinel, working in collaboration with MedPage Today. For several years, Fauber has doggedly covered conflicts of interest in academic medicine, ethical problems, the growth in pain medicine and the resulting rise in painkiller addictions and deaths. As part of his Side Effects series, in February 2012, Fauber wrote about the American Pain Foundation and other groups that promote pain pills: Painkiller boom fueled by networking:”

• Making a Name for Yourself in the Ethics Busines (Chronicle of Higher Education, May 22, 2012)

By Carl Elliott

Let’s start with a quiz.  Can you tell which of these awards is real?

A) The Exxon Valdez Prize in Environmental Ethics

B) The Goldman Sachs Endowment in Business Ethics

C) The Richard Milhous Nixon Award for Ethics in Government

D) The Pfizer Fellowship in Bioethics

If you guessed D), you win. …

•  “Missing the Target: When Practitioners Harm More Than Heal.
  Two day conference at Georgetown University, June 14-15,  an Adriane Fugh-Berman’s PharmedOut.org event
  

  Topics Include:

  • “The Underuse of Classic Drugs”
  • “Are Medical Devices and Drugs Adequately Regulated?”
  • “Protecting Patients in Industry-Funded Trials”
  • “Risks of Cardiovascular Devices”
  • “Cancer Risks from CT Scans”
  • “Pharmaceutical Marketing and Adverse Health Outcomes”

   

Related articles

• American Pain Foundation Shuts Down as Senators Launch Investigation of Prescription Narcotics (propublica.org)
• Vets’ pain advocacy group shuts down amid federal investigation (stripes.com)

Study posits a theory of moral behavior

From the 22 February 2012 Eureka news alert

Researchers say theory may help explain ethical lapses that led to recession

WASHINGTON, DC, February 21, 2012 — Why do some people behave morally while others do not? Sociologists at the University of California, Riverside and California State University, Northridge have developed a theory of the moral self that may help explain the ethical lapses in the banking, investment, and mortgage-lending industries that nearly ruined the U.S. economy.

For decades, sociologists have posited that individual behavior results from cultural expectations about how to act in specific situations. In a study, “A Theory of the Self for the Sociology of Morality,” published in the February issue of the American Sociological Review, Jan E. Stets of UC Riverside and Michael J. Carter of CSU Northridge found that how individuals see themselves in moral terms is also an important motivator of behavior.

Those bankers, stockbrokers, and mortgage lenders whose actions helped cause the recession were able to act as they did, seemingly without shame or guilt, perhaps because their moral identity standard was set at a low level, and the behavior that followed from their personal standard went unchallenged by their colleagues, Stets explained.

“To the extent that others verify or confirm the meanings set by a person’s identity standard and expressed in a person’s behavior, the more the person will continue to engage in these behaviors,” Stets said of the theory of moral identity she and Carter advance. “One’s identity standard guides his or her behavior. Then the person sees the reactions of others to his or her behavior. If others have a low moral identity and do not challenge the illicit behavior that follows from a person’s identity standard, then the person will continue to do what he or she is doing. This is how immoral practices can emerge…

…

Wherever individuals are located on this continuum, they act with the goal of verifying the meanings of who they are that is set by their moral identity standard, Stets and Carter said. “We found that individuals with a high moral identity score were more likely to behave morally, while those with a low moral identity score were less likely to behave morally. Respondents who received feedback from others that did not verify their moral identity standard were more likely to report guilt and shame than those whose identities were verified,” they said.

The goal is to live up to one’s self-view however that appears across the moral continuum from being very uncaring and unjust to very caring and very just, the researchers said. “When the meanings of one’s behavior based on feedback from others are inconsistent with the meanings in one’s identity standard, the person will feel bad,” they said.

More research is needed to identify the source of moral identity meanings,….

 

Related articles

• Effects of Anger, Guilt, and Envy on Moral Hypocrisy (psp.sagepub.com)
• Study posits a theory of moral behavior (esciencenews.com)
• Study posits a theory of moral behavior (eurekalert.org)
• Study posits a theory of moral behavior (physorg.com)
• Morality in Bullying: What is Right and What is Wrong? (education.com)

VaccineEthics.org – A Great Source for Summaries, News, Links to Published Items, and Additional Resources

Came across this Web site via a blog posting at Life of a Lab Rat  (imho a great blog to follow- well grounded and informative on a nice range of topics)

Here’s a brief breakdown of Vaccines.org

• Issue Briefs -essays that review significant topics, developments, and controversies in vaccine ethics and policy.
  these summaries reflect facts, ethical issues, and varied opinions by professionals (including policy makers)
•  News Blog
• Bibliography -over 1300 items published since 1995 in scholarly journals, government reports, the popular media, and books; searchable
• Resources include links to vaccine research institutions and programs, relevant government (US and other) agencies, professional organizations, and more

Related articles

• To Vaccinate or Not to Vaccinate? (education.com)
• We need an app for credible information on vaccines (kevinmd.com)

  “…

  What if we had real time information about our schools? About our neighborhood? What if Google mapped our rates of protection from vaccinations? What if we had a smart phone app that provided us yearly data on school immunization/exemption rates when we selected a kindergarten? Why not an app for that?

  So what if we gave new parents the tools to help educate Aunt Judy who refuses the Tdap shot. …

  …

  We have an opportunity to harness the tools of social media to affect real change and deconstruct barriers. Patients don’t only want more credible science, they want the truth from a trusted partner. The real story, the real facts. We patients want access to why/what/how to protect our children. Doctors need to be communicating online as a part of their day. We already know that parents trust the pediatrician more than anyone else when it comes to questions about vaccine safety. And we’ve known this for a long time. Dr. Diekema hints at online opportunity here:

  Fourth, clinicians, health care organizations, and public health departments must learn to use the tools of persuasion effectively. In The Art of Rhetoric, Aristotle argued that persuasion requires not only a reasonable argument and supporting data, but also a messenger who is trustworthy and attentive to the audience and a message that engages the audience emotionally.
• Childhood Immunizations and Vaccinations | Special Edition | Education.com (education.com)
• How bacteria behind serious childhood disease evolve to evade vaccines (jflahiff.wordpress.com)

American College of Physicians Ethics Manual Sixth Edition

From the article abstract about the revised ethics manual

The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.

The full review of this manual by the ACP may be found here

Related articles

• Ethics Manual Examines Emerging Issues In Medical Ethics – American College Of Physicians (medicalnewstoday.com)
• ACP’s Ethics Manual examines emerging issues in medical ethics (medicalxpress.com)
• News From The Annals Of Internal Medicine: Jan. 3, 2012 (medicalnewstoday.com)

Autonomous Individual or Cog In The Wheel? [Blog Item at The Public’s Health]

Autonomous Individual or Cog In The Wheel? [ The Public’s Health]

Excerpt from the 29 December 2011 blog item

Although a community can only be as healthy as its collective individuals, by name alone, public health implies promoting wellbeing at the population level, even at the expense of the individual. There are two often-mentioned competing concepts in public health: the principle of autonomy and the ethical theory of utilitarianism.

Autonomy implies individuals have control over their lives and should be able to make decisions governing their health, as they are the only ones who truly understand their own personal choices and lifestyle. For example, if one of us as an individual chooses to consume high fat or high sugar foods, then we should be able to do so without the government imposing taxes on our unhealthy products of choice. It is our body alone, and no one should tell us how to treat it.

Utilitarianism, on the other hand, is an ethical theory that guides decisions based on the act that will produce the greatest benefit to the greatest number of people. …

Read the entire posting by Dr. Rubin here

Corporate funding of research

Corporate funding of research.

From the  December 2, 2011 posting at Ethics Beyond Compliance

Many of us are suspicious of health and safety claims based on research funded by corporations that get rich off public confidence in the health and safety of their products. I don’t really trust manufacturers of drugs or genetically modified foods to tell me that they are safe. I also would feel better hearing that an oil spill is no threat to life or environment from someone other than the company that spilled the oil. (Many people seem to have made one inexplicable exception to this rule, which I will mention in the postscript.)

Further, when corporations fund research projects or labs, they gain control over what information is published. The scientists involved may have enough integrity to conduct rigorous research, but unwanted results are likely to be suppressed, especially if they will hurt the bottom line. This may be justified by claiming that only “useful” data need be published, but negative data can also be useful and can avoid wasted money and energy. If one researcher finds that something doesn’t work, publishing that data can help others avoid the same mistakes. Of course, researchers do share data, but some studies are also suppressed. Publication of misleading data and suppression of useful data are two possible hazards of corporations funding research that will affect their bottom line.

On the other hand, if corporations are the ones to benefit from research, it seems they should bear the cost of supporting labs, scientists, and related endeavors….

Are doing harm and allowing harm equivalent? Ask fMRI

Looking at a moral choice Test subjects who feel that doing active harm is morally the same as allowing harm to occur will show more brain activity. The notion that active harm is worse appears to be automatic, a psychological default requiring less thought. (Credit: Cushman Lab/Brown University)

Are doing harm and allowing harm equivalent? Ask fMRI

Actions trigger immediate indignance. Evaluating passive harms requires more thought

From the 2 December 2011 Science News article

PROVIDENCE, R.I. [Brown University] — People typically say they are invoking an ethical principle when they judge acts that cause harm more harshly than willful inaction that allows that same harm to occur. That difference is even codified in criminal law. A new study based on brain scans, however, shows that people make that moral distinction automatically. Researchers found that it requires conscious reasoning to decide that active and passive behaviors that are equally harmful are equally wrong.

For example (see below), an overly competitive figure skater in one case loosens the skate blade of a rival, or in another case, notices that the blade is loose and fails to warn anyone. In both cases, the rival skater loses the competition and is seriously injured. Whether it is by acting, or willfully failing to act, the overly competitive skater did the same harm.

“What it looks like is when you see somebody actively harm another person that triggers a strong automatic response,” said Brown University psychologist Fiery Cushman. “You don’t have to think very deliberatively about it. You just perceive it as morally wrong. When a person allows harm that they could easily prevent, that actually requires more carefully controlled deliberative thinking [to view as wrong].”

The Student Source: Medical Resources and Software

 

From the 19 August 2011 Scout Report item 

For students new to medical school, parsing out the most relevant and helpful information from a seemingly limitless supply of materials can be daunting.  The links are divided into two dozen topical areas, such as “Gross Anatomy”, “Nephrology”, and “Surgery”. Each section contains links from reliable sources, including the University of Toronto, Oxford University, and the University of Colorado Health Sciences Center. The “Gross Anatomy” area is very thorough, as it contains over twenty resources that provide an overview of anatomy, anatomical slide shows, and so on

Click here for The Student Source: Medical Resources and Software

Related Resource

• 

            Medical student.com

 

Academics ‘guest authoring’ ghostwritten medical journal articles should be charged with fraud, legal experts argue

From the 3 August 2011 Medical News Today article

ScienceDaily (Aug. 3, 2011) — Two University of Toronto Faculty of Law professors argue that academics who ‘lend’ their names, and receive substantial credit, as guest authors of medical and scientific articles ghostwritten by industry writers, should be charged with professional and academic misconduct and fraud, even if they contain factually correct information.

In an article published in PLoS Medicine, Professors Simon Stern and Trudo Lemmens argue “Guest authorship is a disturbing violation of academic integrity standards, which form the basis of scientific reliability.” In addition, “The false respectability afforded to claims of safety and effectiveness through the use of academic investigators risks undermining the integrity of biomedical research and patient care.”

In “Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles,” Stern and Lemmens argue that since medical journals, academic institutions, and professional disciplinary bodies have not succeeded in enforcing effective sanctions, a more successful deterrence would be through the imposition of legal liability on the guest authors, “and may give rise to claims that could be pursued in a class action based on the Racketeer Influenced and Corrupt Organizations Act (RICO).”…

Read the entire news article
Journal Reference:
Simon Stern, Trudo Lemmens. Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles. PLoS Medicine, 2011; 8 (8): e1001070 DOI: 10.1371/journal.pmed.1001070

‘Pinkwashing’ is a form of social injustice asserts article in Environmental Justice

Image via Wikipedia

From the 7 July 2011 Eureka news alert

New Rochelle, NY, July 7, 2011—Companies that try to increase sales of their products by adopting the color pink and pink ribbons to imply that they support breast cancer research—a practice called pinkwashing—but at the same time permit the use of chemicals shown to cause cancer are committing a form of social injustice against women, according to a thought-provoking article in Environmental Justice, a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com) The entire issue is available online at www.liebertpub.com/env

Amy Lubitow, Portland State University (Oregon), and Mia Davis, Campaign for Safe Cosmetics (Boston, MA), contend that aligning oneself with a cause such as breast cancer, while carrying out research, manufacturing, or other types of policies or processes that involve the use of chemicals with a proven link to cancer crosses a critical line between just and unjust practices. The authors state that “pinkwashing simultaneously increases profits and potentially contributes to increasing cancer rates and obscures an environmental health discourse that recognizes the environmental causes of breast cancer…” They support and expand on this view in the article entitled, “Pastel Injustice: The Corporate Use of Pinkwashing for Profit.”

“The authors of this article draw needed attention to the dangerous use of consumers’ social and sometimes environmental consciousness by institutions who contribute to environmental health disparities. The blind financial support of these entities, by affected consumers, is a form of environmental injustice that is clearly elucidated by the authors,” said Sylvia Hood Washington, PhD, ND, MSE, MPH, Editor-in-Chief of Environmental Justice, and Research Associate Professor at the University of Illinois at Chicago School of Public Health.

Related articles

• Sick of the Pink (thehealthyhappyhome.wordpress.com)

Counterbalance Interactive Library provides views on complex issues

The Counterbalance Interactive Library*** offers  new views on complex issues from science, ethics, philosophy, and religion. Here you’ll find extensive resources on the evolution/creation controversy, biomedical ethical challenges, and much more.

A sampling of health and medical related topic sets

• AAAS Report on Stem-Cells
• E. Coli at the No Free Lunchroom
• Genetic Engineering and Food
• Genetics and Ethics
• Stem-Cell Debate: Ethical Questions

From the About page

About Counterbalance Foundation Counterbalance is a non-profit educational organization working to promote counterbalanced perspectives on complex issues.  It is our hope that individuals, the academic community, and society as a whole will benefit from a struggle toward integrated and counterbalanced views. Counterbalance provides design, consulting, and technical services. It is our intention to use our considerable experience in these areas to serve as a catalyst by. Helping make existing multidisciplinary research work accessible to a wider audience, principally though the use of interactive technologies. Helping collaboration within, and among research groups by providing on-line technology services, such as the shared Meta-Library andAutoReference tools. Our services are used by PBS Online, The Center for Theology and the Natural Sciences, the AAAS, Science and Religion Forum (UK), and others. Counterbalance is funded by donations and the Adrian M. Wyard Charitable Trust.

Related Articles

• Ethics of Stem Cell Research: i (somescientistsbelieve.wordpress.com)
• Ethics Education Library | Ethics education resources in engineering & the sciences (ethics.iit.edu)

US Department of Defense Patient Safety Program

The US Department of Defense Patient Safety Program was “was created [in 2001] to identify and report actual and potential problems in medical systems and processes and to implement effective actions to improve patient safety and health care quality throughout the MHS [Military Health System].

The Welcome Statement stresses that they “encourage a systems approach to creating a safer patient environment; engaging MHS leadership; promoting collaboration across all three services; and fostering trust, transparency, teamwork, and communication.”

The Home Page has a well organized Site Map with essential links, social media links, education/training links, and links to research and news items.

While many educational resources (as continuing education courses) are closed to the public, these educational items are freely available to all.  [Descriptions are from the Patient Safety Program Web Page]

• Patient Falls Reduction Toolkit: Falls have been the number one harm event reported to the Department of Defense (DoD) Patient Safety Analysis Center (PSAC) since its inception. These tools are offered as guidance and are designed to assist you with creating an institutional awareness and response to patient falls – education, prevention, assessment, reassessment, intervention, and continuous improvement.Click here to access the Patient Falls Reduction Toolkit.
  
  
• Professional Conduct Toolkit: The toolkit is designed for health professionals who may be serving in leadership roles or who are seeking resources for addressing behaviors that negatively impact patient safety and that disrupt the clinical work environment.

Click here to access the Professional Conduct Toolkit

• Situation, Background, Assessment, Recommendation (SBAR) Toolkit: Evidence shows that use of a structured communication tool known as SBAR can improve information exchange among healthcare team members and reduce the rate of adverse events.

Click here to access the Situation, Background, Assessment, Recommendation (SBAR) Toolkit.

Drug Maker Wrote Book Under 2 Doctors’ Names, Documents Say

Entire medical textbook written by pharmaceutical company …”a new level of chutzpah”

Excerpts from the November 2009 NY Times article

Two prominent authors of a 1999 book teaching family doctors how to treat psychiatric disorders provided acknowledgment in the preface for an “unrestricted educational grant” from a major pharmaceutical company.But the drug maker, then known as SmithKline Beecham, actually had much more involvement than the book described, newly disclosed documents show. The grant paid for a writing company to develop the outline and text for the two named authors, the documents show, and then the writing company said it planned to show three drafts directly to the pharmaceutical company for comments and “sign-off” and page proofs for “final approval.”

On a related note…Playing Doctor: How to Spin Pharmaceutical Research

An excerpt from this December 2010 Atlantic article

His first assignment was to produce scientific abstracts for studies of a newly approved antibiotic. Unfortunately, the antibiotic had a major weakness: it did not work against pneumococcus, one of the most common bugs a doctor will see. But this shortcoming was not something that the drug’s manufacturer— hich was funding the articles and abstracts—was keen to point out. So David and his fellow medical writers were told to avoid the topic.

Seven Ways Medical Conflicts of Interest Are Disguised

From a November 22, 2010 blog item by Martha Rosenberg

Still, disclosure is tricky for medical journals whose lifeblood is often drug ads and reprints of articles for drug companies to pass out to physicians. Here are some of the ways conflicts of interest are finessed. 


Omnibus Disclosure. All of a study’s authors are listed with all the pharma links in one block of solid type. Who goes with whom? You’ll never know, but the author with no links sure isn’t happy about shared guilt. 


Initials. “R.L.T. has consulted for Merck” is set in 8-point type at the end of the article. Will readers return to the study’s start, five pages ago, where there are eight authors, four with first names that begin with R? 


Disclosures You Have to Work For. COIs of CME faculty are often given online, but the information is tucked away in a pull-down, scroll menu. It is user-unfriendly—like the drug side effects found on the scrolling ads on the same site. 


One Disclosure Is Enough. When a previous article is cited in journal letters sections, the author disclosures are said to “be found with the original article.” Surely you have that issue, published four months ago, on your desk. 


Protective Coloring. Disclosures of drug company links are embedded between government grants and charitable foundations. Government grants and charitable foundations are not conflicts of interest. 


Paying Customers Only. Twenty million citations of medical literature appear on the U.S. National Library of Medicine website. Many have authors’ institutions and e-mails. But do the abstracts show COIs? Not unless you’re a paid subscriber. Password please. 


Paying Customers Only, Even When You Are Reading a Hard Copy. In hard copies of the Aug. 5 New England Journal of Medicine (NEJM), the disclosures of authors of “Suicide-Related Events in Patients Treated with Antiepileptic Drugs” are absent and said to be found with the “full text” of the article at NEJM.org. 



Fewer U.S. Docs Accepting Perks from Industry

But nearly 84% still report some relationship with companies, results show

From a November 8, 2010 Health Day news item By Robert Preidt

MONDAY, Nov. 8 (HealthDay News) — U.S. physicians‘ links with drug makers, medical device manufacturers and other health-related companies have decreased since 2004, but many doctors still have ties to these businesses, new research shows.

A 2004 survey found that about four out of five doctors accepted gifts of food and beverages from industry in their workplaces and more than 75 percent were given drug samples. In addition, more than one-third accepted reimbursement from companies for professional meetings or continued medical education, and more than one-quarter accepted payment for consulting, speaking or clinical trials.

The new 2009 survey of 1,891 primary care physicians and specialists found that nearly 84 percent reported some type of relationship with industry in the previous year. Nearly two-thirds (63.8 percent) accepted drug samples, about 70 percent received food and beverages, 18 percent received reimbursements, and 14 percent were paid for professional services.

The findings are published in the Nov. 8 issue of the journal Archives of Internal Medicine [free full text article].

Certain types of specialists were more likely to have industry ties. For example, these connections were more common among cardiologists (92.8 percent) than psychiatrists (79.8 percent). The type of practice also made a difference.

“Physicians in solo or two-person practices and group practices were significantly more likely than those in hospital and medical school settings to receive samples, reimbursements and gifts. However, physicians in medical schools were most likely to receive payments from industry,” the researchers wrote.

“These data clearly show that physician behavior, at least with respect to managing conflicts of interest, is mutable in a relatively short period,” the study authors concluded. “However, given that 83.8 percent of physicians have physician-industry relationships, it is clear that industry still has substantial financial links with the nation’s physicians. These findings support the ongoing need for a national system of disclosure of physician-industry relationships.”

SOURCE: JAMA/Archives journals, news release, Nov. 8, 2010

 

 

Psychopaths May Lack Understanding of Social Contracts

From a November 5, 2010 Health Day news item by Robert Preidt

FRIDAY, Nov. 5 (HealthDay News) — Impaired understanding of how social contracts work and why people need to take precautions may explain why psychopaths cheat and take risks even though they know right from wrong, a new study suggests.

Although less than 1 percent of people in the United States are psychopaths, they account for 20 percent of the prison population because of their tendency for impulsive, destructive and harmful behavior, noted the University of New Mexico researchers.

Previous studies have shown that psychopaths know the difference between right and wrong and give typical responses when presented with an example of a moral dilemma. This study  [in the October 2010 issue of  Psychological Science] ***examined another type of reasoning — thinking about precautions and social contracts……

….”This work suggests that psychopaths don’t understand cheating in the normal way, so they might not realize when they’re cheating other people or when other people would react badly to cheating,” study co-author Elsa Ermer said in an Association for Psychological Science news release.

She added that psychopaths’ inability to reason about precautions may explain why they take risks and commit impulsive acts that land them in trouble. It appears they have difficulty “understanding when they can avoid negative consequences of a risk by taking a precaution,” Ermer said.

SOURCE: Association for Psychological Science, news release, Nov. 3, 2010

A related news item.. Logic of a psychopath..

***Click here for suggestions on how to get this article for free or at low cost

Two New MedlinePlus Items of Note

MedlinePlus is a goldmine of links to free and trusted health and medical Web sites.
It is sponsored by the US National Library of Medicine and the US National Institutes of Health.

—->Recently MedlinePlus has added a Medical Ethics page with links to overviews, news items, specific conditions, and news articles.

Additionally, a  good list of Medical Ethics Web sites from the College of the Holy Cross is available here.

—->MedlinePlus is undergoing a major Web site redesign. Check here for details and the opportunity to provide feedback.