Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.     

Sexual Minority Youth,Social Change,and Health: A Developmental Collision

Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people—perhaps particularly for youth—has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. The authors suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility.     

Quality of written record following mock eyewitness testimony: Note taking should be a minimum standard!

By using a video‐based narrative (unidirectional) eyewitness statement of an alleged victim, participants were asked to imagine they were police officers. We compared the quality of mock police officer written records in a between‐subjects design comprising three conditions: (a) a free recall (n = 27), (b) a free recall by using recall strategies of the cognitive interview (n = 27), or (c) note taking while watching the video (n = 26). The quality of the reports was determined by the amount of correctly recalled details, omitted details, added details (commission errors), and changed details (confabulations). As predicted, the number of correct details was higher in the “Note Taking” condition whereas performance in the “Free Recall” and in the “Cognitive Interview” conditions did not differ. Higher verbal memory ability resulted in a better quality of the written records. Our results suggest that note taking facilitates the quality of written records.     

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children’s externalizing behaviors and parenting problems, was associated with improvements in parents’ emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children’s improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents’ self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents’ self-report of children’s symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children’s symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents’ perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children’s externalizing behaviors.     

War and disaster in Sri Lanka: Implications for widows' family adjustment and perception of self‐efficacy in caring for one's family

The data for this study were collected in 2014 from widows in Eastern Sri Lanka whose spouses died in the civil war, tsunami, or from health‐related problems. Conservation of resources (COR) theory was used as a lens to examine the extent to which war and tsunami‐related damages and family problems predict variation in social support, family adjustment and a perception of self‐efficacy in caring for one's family as reported by widowed women. We also investigated whether social support from the community and social support from family and friends mediated those relationships. Results of a path model fit to the data suggested variation in family adjustment to be negatively predicted by war‐related family problems and positively predicted by the social support of friends and family. Additionally, a sense of self‐efficacy in caring for one's family was found to be inversely predicted by war‐related family problems and tsunami damages. Clinical, social and theoretical implications are discussed as well as directions for further research.     

Quantifying the effects of the differential outcomes procedure in humans: A systematic review and a meta‐analysis

We present a systematic review and a meta‐analysis comparing the differential outcomes procedure to a nondifferential outcomes procedure among clinical and nonclinical populations. Sixty distinct experiments were included in the systematic review, 43 of which were included in the meta‐analysis. We calculated pooled effect sizes for accuracy (overall accuracy, test accuracy, transfer accuracy) and acquisition outcomes (latency, errors, and trials to mastery). The meta‐analysis revealed significant medium‐to‐large effect sizes for all three accuracy measures (pooled effect size range, 0.57 to 1.30). We found relatively greater effect sizes among clinical populations (effect size = 1.04). The single‐subject experimental literature included in the systematic review was consistent with the findings from the group studies, demonstrating improvements in accuracy and speed of learning for the majority of participants. Moderator and subgroup analyses suggest that discrimination difficulty may induce relatively larger differential outcomes effects. The results indicate that the differential outcomes procedure can be a valuable addition to reinforcement‐based interventions.     

Treatment of resistance to change in children with autism

“Resistance to change” represents a core symptom of autism that we conceptualized and assessed as resulting in part due to factors known to govern free‐operant choice. During a free‐choice baseline, participants chose between problematic, resistive responses and an appropriate alternative response. During the asymmetrical‐choice condition, we delivered their most highly preferred item if the participant chose the alternative response (i.e., differential reinforcement of alternative behavior [DRA]). During the guided‐ (Experiment 1) and singular‐ (Experiment 2) choice conditions, we prompted participants to choose the alternative response and then delivered their most highly preferred item (i.e., DRA with escape extinction). All participants learned to tolerate (Experiment 1) or choose (Experiment 2) the alternative response when we combined DRA with escape extinction. After exposure to escape extinction, two participants showed strong maintenance effects with DRA alone. We discuss these finding relative to the effects of DRA and escape extinction on resistance to change.     

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.     

Social categorization and individuation in the own‐age bias

Young adults recognize other young adult faces more accurately than older adult faces, an effect termed the own‐age bias (OAB). The categorization‐individuation model (CIM) proposes that recognition memory biases like the OAB occur as unfamiliar faces are initially quickly categorized. In‐group faces are seen as socially relevant which motivates the processing of individuating facial features. Outgroup faces are processed more superficially with attention to category‐specific information which hinders subsequent recognition. To examine the roles of categorization and individuation in the context of the OAB, participants completed a face recognition task and a speeded age categorization task including young and older adult faces. In the recognition task, half of the participants were given instructions aimed to encourage individuation of other‐age faces. An OAB emerged that was not influenced by individuation instructions, but the magnitude of the OAB was correlated with performance in the categorization task. The larger the categorization advantage for older adult over young adult faces, the larger the OAB. These results support the premise that social categorization processes can affect the subsequent recognition of own‐ and other‐age faces, but do not provide evidence for the effectiveness of individuation instructions in reducing the OAB.