Book reviewed in this article: The Healer's Power. By Howard Brody.

Experts often communicate probabilities verbally (e.g., unlikely) rather than numerically (e.g., 25% chance). Although criticism has focused on the vagueness of verbal probabilities, less attention has been given to the potential unintended, biasing effects of verbal probabilities in communicating probabilities to decision-makers. In four experiments (Ns = 201, 439, 435, 696), we showed that probability format (i.e., verbal vs. numeric) influenced participants’ inferences and decisions following a hypothetical financial expert’s forecast. We observed a format effect for low probability forecasts: verbal (...) probabilities were interpreted more pessimistically than numeric equivalents. We attributed the difference to directionality, a linguistic property that biases attention toward an outcome. In the high-probability conditions, the directionality of verbal and numeric probabilities aligned (both were positive), whereas they differed in the low-probability conditions (verbal probabilities were more negative). Participants inferred recommendations congruent with the communicated direction and these inferences mediated the effect of probability format on decisions. (shrink)

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire (...) for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics. (shrink)

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants. The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols. Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about (...) participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics. (shrink)

Psychological literacy, the ability to apply psychological knowledge to personal, family, occupational, community and societal challenges, is promoted as the primary outcome of an undergraduate education in psychology. As the concept of psychological literacy becomes increasingly adopted as the core business of undergraduate psychology training courses world-wide, there is urgent need for the construct to be accurately measured so that student and institutional level progress can be assessed and monitored. Key to the measurement of psychological literacy is determining the underlying (...) factor-structure of psychological literacy. In this paper we provide a first approximation of the measurement of psychological literacy by identifying and evaluating self-report measures for psychological literacy. Multi-item and single-item self-report measures of each of the proposed nine dimensions of psychological literacy were completed by two samples (N = 218 and N = 381) of undergraduate psychology students at an Australian university. Single and multi-item measures of each dimension were weakly to moderately correlated. Exploratory and confirmatory factor analyses of multi-item measures indicated a higher order three factor solution best represented the construct of psychological literacy. The three factors were reflective processes, generic graduate attributes, and psychology as a helping profession. For the measurement of psychological literacy to progress there is a need to further... (shrink)

All treatments, even those labeled as supportive, have burdens as well as benefits. Patients and their surrogates have the right to finally decide whether the offered treatment's cost-benefit calculation is acceptable.

An informed consent and voluntary assent in biomedical research with adolescents is contingent on a variety of factors, including adolescent and parent perceptions of research risk, benefit, and decision-making autonomy. Thirty-seven adolescents with asthma and their parents evaluated a high or low aversion form of a pediatric asthma research vignette and provided an enrollment decision; their perceptions of family influence over the participation decision; and evaluations of risk, aversion, benefit, and burden of study procedures. Adolescents and their parents agreed on (...) research participation decisions 74% of the time, yet both claimed ultimate responsibility for the participation decision. Both rated most study procedures as significantly more aversive than risky. Parents were more likely to rate aspects of the hypothetical study as beneficial and to provide higher risk ratings for procedures. Disagreements concerning research participation decisions and decision-making autonomy have implications for the exercise of voluntary assent in biomedical research. (shrink)

Schizophrenia affects more than 1% of the world's population, causing great personal suffering and socioeconomic burden. These costs associated with schizophrenia necessitate inquiry into the causes and treatment of the illness but generate ethical challenges related to the specific nature and deficits of the illness itself. In this article, we present a systematic analysis of narrative data from 63 people living with the illness of schizophrenia collected through semistructured interviews about their attitudes, beliefs, and experiences related to psychiatric research. In (...) the comments of these individuals, half of whom had had prior personal experience in research protocols, we identified factors influencing openness toward research involvement as well as deterrents that appear to lessen interest in participation. Clear response pattern differences emerged between those with prior research experience and those without such experience. In the discussion, we explore these key findings and outline the implications for safeguards in mental illness research. (shrink)

Originally published in 1967 Medieval Minds looks at the Middle Ages as a period with changing attitudes towards mental health and its treatment. The book argues that it was a period that that bridged the ancient with the modern, ignorance with knowledge and superstition with science. The Middle Ages spanned almost a millennium in the history of the humanities and provided the people of this period with the benefit of this knowledge. The book looks at the promise and progress which (...) was reflected by thinkers such as Augustin and Aurelianus, Alexander of Tralles and Paul of Aegina. The book also looks at martyrs like Valentine and Dympna, and the patrons of those afflicted with illnesses such as epilepsy and insanity. Written by the psychologist Thomas Francis Graham, this book provides a distinct and unique insight into the mind of those living in the medieval period and will be of interest to academics of history and literature alike. (shrink)

In mid-1996, the United States Supreme Court agreed to hear arguments and rule on two lower court cases that would, if upheld, legalize physician-assisted suicide in twelve states, including California. At about the same time, at a national meeting dealing with this controversial topic, several participants from the San Francisco Bay Area got together to ask, Based on the old principle of the suggestion was made that the local ethics committee network might be interested in developing guidelines for the care (...) of patients at the end of life in the unlikely event that laws would change by Supreme Court action. Thus the coordinator of the Bay Area Network of Ethics Committees (BANEC) and several BANEC members began to discuss this question. (shrink)

Human clinical research has become a huge economic enterprise (Morin et al. 2002; Noah 2002). Because the human subject at the center can be so easily marginalized, many commentators recommend spec...

Some say that public policy can be made without the benefit of theory--that it emerges, instead, through trial-and-error. Others see genuine philosophical issues in public affairs but try to resolve them through fanciful examples. Both, argues Robert E. Goodin, are wrong. Goodin--a political scientist who is also an associate editor of Ethics--shows that empirical and ethical theory can and should guide policy. To be useful, however, these philosophical discussions of public affairs must draw upon actual policy experiences rather than (...) contrived cases. Further, they must reflect the broader social consequences of policies rather than just the dilemmas of personal conscience. Effectively integrating the literatures of social science, policy science, and philosophy, Goodin provides a theoretically sophisticated yet empirically well-grounded analysis of public policies, the principles underlying them, the institutions shaping them, and the excuses offered for their failures. This analysis is enhanced by the author's discussion of such specific cases as the disposal of nuclear wastes and the priority accorded national defense--cases that illustrate Goodin's theoretical and methodological framework for approaching policy issues. (shrink)

The current investigation was designed to examine the association of parenting during late childhood and early adolescence, a time of rapid physical development, with biological propensity for inflammation. Based on life course theory, it was hypothesized that parenting during this period of rapid growth and development would be associated with biological outcomes and self-reported health assessed in young adulthood. It was expected that association of parenting with health would be mediated either by effects on methylation of a key inflammatory factor, (...) Tumor necrosis factor (TNF), or else by association with a pro-inflammatory shift in the distribution of mononuclear blood cells. Supporting expectations, in a sample of 398 African American youth residing in rural Georgia, followed from age 11 to age 19, parenting at ages 11–13 was associated with youth reports of better health at age 19. We found that parenting was associated with changes in TNF methylation as well as with changes in cell-type composition. However, whereas methylation of TNF was a significant mediator of the association of parenting with young adult health, variation in mononuclear white blood cell types was not a significant mediator of the association of parenting with young adult health. The current research suggests the potential value of examining the health-related effects of parenting in late childhood and early adolescence. Further examination of protection against pro-inflammatory tendencies conferred by parenting appears warranted. (shrink)

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

I will, in this paper, set out the philosophical foundations and the basic structure of a new theory of justice. I will argue that both these foundations and the theory which is based upon them are intuitively attractive and theoretically sound. Finally, I will argue that both are supported by the fact that they lead to attractive implications such as the following: One can justify at least some governmental redistributive programs which presuppose that those receiving the wealth have a right (...) to it, without being committed to any form of egalitarianism. The justification for these redistributive programs respects property entitlements; it argues, in effect, that property entitlements and rights to some redistribution of wealth presuppose each other, rather than being in conflict with each other. The amount of redistribution to which each indigent person is entitled is directly proportional to the wealth of the society in question and inversely proportional to the number of indigents in the society in question. There are at this stage in the history of Western thought few entirely new ideas in philosophy. Too much has been written about the important issues to allow for entirely new approaches. My theory is no exception to these generalizations, for it draws upon the tradition of John Locke, of the agrarian reforms such as Paine, Spence, and Ogilvie, and of libertarian writers such as Robert Nozick. Nevertheless, I will argue, the resulting theory is a significant advance over the ideas of these earlier writers. (shrink)