HMOs and physician conflicts of interest

In a recent issue of this journal, Francis Beckwith's "The Ethics of Referral Kickbacks and Self-Referral and the HMO Physician as Gatekeeper: An Ethical Analysis" provided an admirably provocative defense of the claim that Health Maintenance Organization (HMO) physician gatekeepers are morally indistinguishable from physician referral kickbacks and self-referrals. Here I will argue that Beckwith's defense is weak. I will also make some tentative suggestions about approaching the issue of physician conflicts of interest.     

Propagation of depth information from local regions in 3-D scenes

The effects of regions with local linear perspective on judgments of the depth separation between two objects in a scene were investigated for scenes consisting of a ground plane, a quadrilateral region, and two poles separated in depth. The poles were either inside or outside the region. Two types of displays were used: motion-parallax dot displays, and a still photograph of a real scene on which computer-generated regions and objects were superimposed. Judged depth separations were greater for regions with greater linear perspective, both for objects inside and outside the region. In most cases, the effect of the region's shape was reduced for objects outside the region. Some systematic differences were found between the two types of displays. For example, adding a region with any shape increased judged depth in motion-parallax displays, but only high-perspective regions increased judged depth in real-scene displays. We conclude that depth information present in local regions affects perceived depth within the region, and that these effects propagate, to a lesser degree, outside the region.     

Organisation: what levels of processing are levels of

The psychology of thought and memory has historically been concerned with a struggle between associationism and its opponents. Organisation theory--in part an offspring of Gestalt concepts--has been the most successful and vocal of these contenders. The levels-of-processing framework has been a part of the effort to overcome associationist predilections. Aspects of principles of organisation and of the recent history of organisation theory are presented, followed by an analysis of the levels-of-processing approach in terms of organisational concepts.     

Pessimism

The problem of pessimism is the secular analogue to the evidential problem of evil facing traditional theism. The traditional theist must argue two things: that the evidence shows that this is on balance a good world and that it is the best possible world. Though the secular optimist who advocates any form of secular moral theory need not argue that the current and future world will likely be the best possible world, she nonetheless must argue that were there a clean solution to the problem of current and future suffering in which all sentient life could be instantly and painlessly eliminated, we would have reasons not to employ the clean solution because the future promises to bring on balance a good world in which the evil of human and animal suffering is outweighed by whatever is good in the world. Pessimism is the view that the evidence argues against secular optimism. It is argued here that it is anything but clear that secular optimism is warranted when viewed from an impersonal point of view. The problem is then evaluated from the personal point of view in which a form of personal optimism is defended even in the face of impersonal pessimism.     

Opportunistic use of cognitive smokescreens by araneophagic jumping spiders

Little is known about how a prey species' cognitive limitations might shape a predator's prey-capture strategy. A specific hypothesis is investigated: predators take advantage of times when the prey's attention is focussed on its own prey. Portia fimbriata, an araneophagic jumping spider (Salticidae) from Queensland, is shown in a series of 11 experiments to exploit opportunistically a situation in which a web-building spider on which it preys, Zosis genicularis (Uloboridae), is preoccupied with wrapping up its own prey. Experimental evidence supports three conclusions: (1) while relying on optical cues alone, P. fimbriata perceives when Z. genicularis is wrapping up prey; (2) when busy wrapping up prey, the responsiveness of Z. genicularis to cues from potential predators is diminished; and (3) P. fimbriata moves primarily during intervals when Z. genicularis is busy wrapping up prey. P. fimbriata's strategy is effective partly because the wrapping behaviour of Z. genicularis masks the web signals generated by the advancing P. fimbriata's footsteps and also because, while wrapping, Z. genicularis' attention is diverted away from predator-revealing cues. Electronic Publication     

Volume Contents

Volume Contents

Volume Contents     

Emotion, plasticity, context, and regulation: perspectives from affective neuroscience

The authors present an overview of the neural bases of emotion. They underscore the role of the prefrontal cortex (PFC) and amygdala in 2 broad approach- and withdrawal-related emotion systems. Components and measures of affective style are identified. Emphasis is given to affective chronometry and a role for the PFC in this process is proposed. Plasticity in the central circuitry of emotion is considered, and implications of data showing experience-induced changes in the hippocampus for understanding psychopathology and stress-related symptoms are discussed. Two key forms of affective plasticity are described--context and regulation. A role for the hippocampus in context-dependent normal and dysfunctional emotional responding is proposed. Finally, implications of these data for understanding the impact on neural circuitry of interventions to promote positive affect and on mechanisms that govern health and disease are considered.     

Vagus nerve stimulation: a new form of therapeutic brain stimulation

Although the vagus nerve has traditionally been considered to perform efferent functions, in reality it performs significant afferent functions as well, carrying information from the body, head, and neck to the brain. Preliminary studies examining this afferent activity led to the theory that vagus nerve stimulation (VNS) could successfully control seizure activity in persons who are refractory to antiepileptic medications. Unlike other forms of brain stimulation, VNS is unable to directly stimulate multiple discrete areas of the brain; however, through several pathways, it is able to relay sensory information to higher brain regions. An implantable VNS device known as the VNSTM NeuroCybernetic Prosthesis (NCP) System has been used in approximately 9,000 epilepsy patients in Europe and the United States since 1994. The implant has reduced seizure frequency by an average of 25% to 30%, with minimal side effects. Studies underway are also showing some degree of success in the management of treatment-refractory depression. The future efficacy of the implantable system in other disorders may depend on whether the implant can be more precisely focused to affect different brain regions. Research in this area is underway.     

The Ponzo illusion affects grip-force but not grip-aperture scaling during prehension movements

Contextual cues such as linear perspective and relative size can exert a powerful effect on the perception of objects. This fact is demonstrated by the illusory effects that can be induced by such cues (e.g., the Ponzo railway track and Titchener circles illusions). Several recent studies have reported, however, that visual illusions based on such cues have little or no influence on the visuomotor mechanisms used to guide hand action. Furthermore, evidence of this sort has been cited in support of a distinction between visual perception and the visual control of action. In the current study, the authors investigated the effect of the Ponzo visual illusion on the control of hand action, specifically, the scaling of grip force and grip aperture during prehension movements. The results demonstrate that grip force scaling is significantly influenced by the Ponzo visual illusion, whereas the scaling of grip aperture is unaffected by the illusion.