Should physicians be Bayesian agents?

Because physicians use scientific inference for the generalizations of individual observations and the application of general knowledge to particular situations, the Bayesian probability solution to the problem of induction has been proposed and frequently utilized. Several problems with the Bayesian approach are introduced and discussed. These include: subjectivity, the favoring of a weak hypothesis, the problem of the false hypothesis, the old evidence/new theory problem and the observation that physicians are not currently Bayesians. To the complaint that the prior probability is subjective, Bayesians reply that there will be ultimate convergence, but the rebuttal to this is that there will not be uniform convergence. Secondly, since the Bayesian scheme favors a weak hypothesis, theories turn out to be a gratuitous risk. The problem with the false hypothesis comes out in the denominator of the theorem, revealing that a factor which is not a theory at all is being considered in the reasoning. On the old evidence/new theory problem old evidence cannot confirm a new theory so that the posterior probability will equal the prior probability. Finally, empiric studies have shown that current physicians are not Bayesians. But on consideration of Bayesian inference as a system of inference, it can be reasoned that physicians should be Bayesians. However, the problem of physicians' and patients' own subjectivity continue to plague this system of medical decision making.     

Three-way metric unfolding via alternating weighted least squares

Three-way unfolding was developed by DeSarbo (1978) and reported in DeSarbo and Carroll (1980, 1981) as a new model to accommodate the analysis of two-mode three-way data (e.g., nonsymmetric proximities for stimulus objects collected over time) and three-mode, three-way data (e.g., subjects rendering preference judgments for various stimuli in different usage occasions or situations). This paper presents a revised objective function and new algorithm which attempt to prevent the common type of degenerate solutions encountered in typical unfolding analysis. We begin with an introduction of the problem and a review of three-way unfolding. The three-way unfolding model, weighted objective function, and new algorithm are presented. Monte Carlo work via a fractional factorial experimental design is described investigating the effect of several data and model factors on overall algorithm performance. Finally, three applications of the methodology are reported illustrating the flexibility and robustness of the procedure.We wish to thank the editor and reviewers for their insightful comments.     

PSYCHOLOGY AND HEALTH: CONTRIBUTIONS OF PSYCHOLOGY TO THE IMPROVEMENT OF HEALTH AND HEALTH CARE

Psychology as both a science and a profession has been closely identified with other disciplines in the broad field of health since the turn of the century. Recent advances in health care have reinforced the growing belief that the promotion of health and the prevention and treatment of illness can be greatly enhanced by incorporating the scientific findings and modern technology of psychology into everyday practices. Outlining the contributions of psychology to health care throughout the world is the primary purpose of this report. In this brief survey, only some of the most timely and relevant issues can be mentioned, together with examples of current work in the field. The reader interested in pursuing these psychological contributions more thoroughly is encouraged to review pertinent references from the citations at the end of this report. After an introductory overview, special attention is given to each of the major areas within the broad field of health care where psychological applications have been particularly useful.     

The varieties of fear

Conclusion I shall conclude with a methodological moral. I have tried to show that there are several fundamentally different kinds of fear. One is a pure propositional attitude, one is partially a bodily state, and one is a relation between a person and a nonpropositional object. Other emotions come in similar varieties, such as hope and happiness, but with significant differences. The state of happiness, for example, does not entail any particular bodily state or feeling. So one lesson is this: it is hard to generalize about the emotions. Further detailed, analytical studies of particular emotions are needed before a general theory of the emotions can be fruitfully attempted.     

Modification of Type A behavior through aerobic exercise

This psychophysiological evaluation of an aerobic exercise program examined specifically whether aerobic training modified Pattern A for those individuals at behavioral risk for developing coronary heart disease, i.e., young Type A individuals. At pretest and posttest of this secondary prevention study, Type A and Type B subjects were assessed in three conditions: aerobic exercise program, nonaerobic activity (Aikido, a martial art) control, and notreatment control. After 10 weeks, Type A but not Type B subjects exhibited lower Pattern A behavior in the aerobic program than in control conditions. Average workout pulse rates and differentially reliable increases in aerobic capacity indicated that aerobic training was indeed aerobic, whereas aikido activity was not. Even though selected nonaerobic factors, such as locus of control and group participation, did not mediate the Pattern A decrease for Type A's when comparing aikido and aerobic conditions, changes in aerobic capacity may have been the mediator. Generalizability of the results and implications for theoretical development and clinical intervention are discussed.     

Automaticity and the capture of attention by a peripheral display change

The proposal that peripheral visual changes (cues) tend to summon attention automatically was tested by studying the effect of peripheral cueing on simple detection latency. Delay between cue onset and target onset, the contingent relationship between cue location and target location, and instructions to subjects were manipulated. Results showed that a peripheral display change could capture attention even when the target was far more likely to appear at an uncued location. When subjects were explicitly informed that targets were likely to appear away from the cued location they were able to suppress this effect, but were unable completely to reverse it by rapidly orienting attention towards the uncued side. Hence the process appears to be automatic in the sense that it occurs unless there are explicit instructions to the contrary. With explicit instructions the processing operation can be suppressed, but not completely reversed. This work was supported by the U.K. Admiralty Research Establishment (Research Agreement No. 53482).     

Pharmacological effects on lateralized behavior

Sixteen student volunteers were administered a placebo and 50 mg. of chlorpromazine in tablet form, on separate occasions, two hours before testing. The three tests measured dichotic listening performance, lateral eye movements while answering questions about spatial location and verbal meaning, and lateralized facial expression while relating pleasant and unpleasant life incidents. Results showed that chlorpromazine increased the number of trials showing an ear advantage in dichotic listening. Chlorpromazine reduced lateral and increased vertical eye movements in response to the questions about spatial location and verbal meaning. Under the placebo both negative and positive emotions were expressed more in the left face. Although chlorpromazine did not affect this lateralization of negative emotions, the expression of positive emotions occurred equally often on the two sides of the face under chlorpromazine. Results may be related to an effect of chlorpromazine on the asymmetrical dopamine pathways of the brain. It is suggested that the findings may be related to a left hemisphere deficit in schizophrenia.