Should Doctors ‘Google’ Their Patients?

by Jalees Rehman

Beware of what you share. Employers now routinely utilize internet search engines or social network searches to obtain information about job applicants. A survey of 2,184 hiring managers and human resource professionals conducted by the online employment website CareerBuilder.com revealed that 39% use social networking sites to research job candidates. Of the group who used social networks to evaluate job applicants, 43% found content on a social networking site that caused them to not hire a candidate, whereas only 19% found information that that has caused them to hire a candidate. The top reasons for rejecting a candidate based on information gleaned from social networking sites were provocative or inappropriate photos/information, including information about the job applicants' history of substance abuse. This should not come as a surprise to job applicants in the US. After all, it is not uncommon for employers to invade the privacy of job applicants by conducting extensive background searches, ranging from the applicant's employment history and credit rating to checking up on any history of lawsuits or run-ins with law enforcement agencies. Some employers also require drug testing of job applicants. The internet and social networking websites merely offer employers an additional array of tools to scrutinize their applicants. But how do we feel about digital sleuthing when it comes to relationship that is very different than the employer-applicant relationship – one which is characterized by profound trust, intimacy and respect, such as the relationship between healthcare providers and their patients?

Internet 1

The Hastings Center Report is a peer-reviewed academic bioethics journal which discusses the ethics of “Googling a Patient” in its most recent issue. It first describes a specific case of a twenty-six year old patient who sees a surgeon and requests a prophylactic mastectomy of both breasts. She says that she does not have breast cancer yet, but that her family is at very high risk for cancer. Her mother, sister, aunts, and a cousin have all had breast cancer; a teenage cousin had ovarian cancer at the age of nineteen; and that her brother was treated for esophageal cancer at the age of fifteen. She also says that she herself has suffered from a form of skin cancer (melanoma) at the age of twenty-five and that she wants to undergo the removal of her breasts without further workup because she wants to avoid developing breast cancer. She says that her prior mammogram had already shown abnormalities and she had been told by another surgeon that she needed the mastectomy.

Such prophylactic mastectomies, i.e. removal of both breasts, are indeed performed if young women are considered to be at very high risk for breast cancer based on their genetic profile and family history. The patient's family history – her mother, sister and aunts being diagnosed with breast cancer – are indicative of a very high risk, but other aspects of the history such as her brother developing esophageal cancer at the age of fifteen are rather unusual. The surgeon confers with the patient's primary care physician prior to performing the mastectomy and is puzzled by the fact that the primary care physician cannot confirm many of the claims made by the patient regarding her prior medical history or her family history. The physicians find no evidence of the patient ever having been diagnosed with a melanoma and they also cannot find documentation of the prior workup. The surgeon then asks a genetic counselor to meet with the patient and help resolve the discrepancies. During the evaluation process, the genetic counselor decides to ‘google' the patient.

Read more »

Duct Tape, Plywood and Philosophy

by Misha Lepetic

When all is finished, the people say, “We did it ourselves.”
~ Tao Te Ching, Verse 17

Gramsci-WomanWhat does philosophy in action look like? Casual thoughts about the discipline may be united by the cliché of the philosopher as a loner. From Archimedes berating a Roman soldier to not “disturb my circles” (which subsequently cost him his head), to Kant's famous provinciality, to Wittgenstein's plunging into the Norwegian winter to work on the Logik, the term “armchair philosopher” might seem to be a tautology. But philosophy – or at least the parts that occupy the intersection of the interesting and the accessible – still concerns itself with the world at large, and our place in it.

New Yorkers got to see a particularly odd example of philosophy in action over the summer when artist Thomas Hirschhorn installed his Gramsci Monument in the central courtyard of a Bronx public housing complex known as Forest Houses. I won't dwell much on Antonio Gramsci himself (see here for a start), but suffice to say he was a man of the people, who died in prison after founding the Italian Communist Party. What is more interesting is how Hirschhorn used Gramsci as a jumping-off point, and where he chose to do it. Completed in 1956, Forest Houses is part and parcel of what anyone would recognize as “the projects” – a scattering of 15 buildings in a towers-in-the-park configuration, populated by nearly 3400 residents, most of whom are minorities and low-income. However, Hirschhorn didn't so much choose the site as it chose him – after visiting 47 public housing projects in the city, Forest Houses was the only one that expressed any interest in his proposal.

The arrival of Hirschhorn and his motley architectural assemblage, which seemed to be made mostly of plywood and duct tape, was met with perplexity by both residents and art critics. As far as the critics go – and hey, someone's got to play the straw man to kick things off, right? – at least one was mightily displeased. Writing in the New York Times, Ken Johnson pooh-poohed Hirschhorn as a “canny conceptualist operator” and opined that the installation would ultimately “be preserved in memory mainly by the high-end art world as just a work by Mr. Hirschhorn, another monument to his monumental ego.”

It's difficult for me to comprehend that Johnson and I visited the same place. The first thing to note is the inappropriateness of the term “installation.” The Gramsci Monument is much more of an intervention. Of course, architects and urbanists are not immune to the charms of this term, either – any bland pop-up café seems to constitute an “intervention” of the street, the urban fabric or what have you, with “dramatic” being the accompanying adjective of choice. But what made Hirschhorn's work really an intervention was its sheer physicality, its uncompromising presence in the courtyard. The towers-in-the-park paradigm, one of the baleful legacies of modernism, was introduced to the US in large measure by Le Corbusier, whose reputation is currently the subject of a risible attempt at rehabilitation by MoMA. The result is an environment of hard vertical and horizontal masonry lines, scrawny trees and threadbare lawns. As a pedestrian, you walk among 12-story brick sentinels, and the absence of any place that can provide a moment of semi-privacy, one of the key signifiers of successful public space, is palpable. The point – which was much in keeping with Le Corbusier's design ideals – was to get you to where you were going, and as efficiently as possible. “No Loitering,” as the signs say.

Read more »

The Uses and Disadvantages of History for Ecological Restoration

by Liam Heneghan

Nietzsche-munch

Click diagram to enlarge

Context: One of the newer biological conservation strategies, ecological restoration, attempts to reverse the degradation of lands set aside for conservation purposes by reinstating, as closely as possible, the species and environmental conditions that existed before recent and large scale disturbances by human activities. A newly emerging framework within restoration ecology – the novel ecosystem paradigm – points out that with global change we are moving into an era for which there is no historical analogue. As a consequence land must be managed without excessive regard for the past which can no longer serve as our guide. This has generated a lot of controversy within the field. I was asked by Irish journalist Paddy Woodworth to speak on a panel on “The historical reference system: critical appraisal of a cornerstone concept in restoration ecology” at a conference of the Society for Ecological Restoration held in Madison Oct 6 -11th 2013. In recent articles and in his new book “Our Once and Future Planet: Restoring the World in the Climate Change Century” Woodworth had been critical of the novel ecosystem paradigm wondering if it does not undermine the case for restoration. I had not realized how controversial the topic had become. Tensions at the conference were running high, and the room in which this panel convened was over capacity with dozens turned away. What follows is the outline of my remark at this session.

On first glance the work of Friedrich Nietzsche (1844–1900), the German philosopher, might not seem especially helpful for restoration ecologists or indeed for anyone contemplating our relationship with the natural world. After all, his work supposedly challenges the foundations of Christianity and traditional morality. Nietzsche’s famous locutions concerning the “death of God” and his extensive discussions of nihilism should, however, be seen as his diagnosis rather than his cure. For Nietzsche our real cultural task is to overcome the annihilation of traditional morality, replacing it with something more life-affirming. The failure of our traditional precepts of value stem from the fact these express what Nietzsche calls the ascetic ideal. This ideal measures the appropriateness of human actions against edicts coming from beyond our natural and earth-bound life. The highest human values, as we traditionally assess them, came from a denial of our natural selves. Nature, in turn, is regarded as having no intrinsic value.

Thus Nietzsche even when he wrote in areas seemingly distant from traditional environmental concerns has useful things to say to us environmentalists. At times, in fact, his aphorisms are those of a poetic naturalist. In The Wanderer and His Shadow (1880, collected in Human, All too Human) he wrote “One has still to be as close to flowers, the grass and the butterflies as is a child, who is not so very much bigger that they are. We adults, on the other hand, have grown up high above them and have to condescend to them; I believe the grass hates us when we confess our love for it.” This is not, of course, to claim that Nietzsche is a traditional naturalist. His concerns are primarily about the thriving of human life, though in this he seems less like a traditional wilderness defender and closer to a contemporary sustainability advocate who seeks to locate a promising future for humans while simultaneously solving environmental problems.

Read more »

Bound for the Future

by Quinn O'Neill

Stanford_Torus_interiorA warm wind blew over the African grassland and stirred the leaves of empty trees. A long time ago, the faint sounds of a nearby tourist lodge were carried on the breeze and the trees cradled sleeping baboons. These baboons were special. Studied by neurobiologist Robert Sapolsky in the 80s, they would sleep in the trees to gain easy access to garbage from the tourists – half eaten hamburgers and leftover drumsticks.1

The practice proved lethal for the baboons, who met their demise when a TB outbreak contaminated the food. Those who frequented the garbage site happened to be the most aggressive and least socially affiliated in their troop. The more socially-oriented and peaceful members were spared, and a curious change occured in the dynamics of the troop, with the remaining baboons subsequently enjoying a persistent peaceful culture with relatively little agression and more grooming.

But that was a long time ago and much had changed. Faced with climate change, human pollution, and habitat loss, the baboon's numbers had dwindled dramatically and few places remained on the planet that could attract human tourists with their wild and natural beauty. Our own “alphas”, for too many decades, had put their own immediate interests above everything else, including collective human well being, animal welfare, and environmental sustainability. Our tar ponds and nuclear waste sites were now too widespread to be hidden from our view and the few remaining old trees, still beautiful were too wise to be enjoyed. “There used to be more of us,” you could almost hear them saying. “We were surrounded by life once.”

Over the years, lots of people had objected to what was taking place even as they watched it unfold. Credible authorities like James Hansen, head of the NASA Goddard institute for Space Studies, and Canadian geneticist and journalist David Suzuki warned of the need to radically reduce CO2 emissions and make environmental issues a priority. Had they been part of the tiny percentage that wielded awesomely concentrated wealth and power, perhaps they could have done something to stop it sooner.

Read more »

A Tribute to Stanley Kauffmann

Stanley-kauffmann-1_0_0

Dorothy Wickenden in TNR:

I started working with Stanley at The New Republic in 1978, when I was twenty-four and he was sixty-two. The best part of my job was proofreading his reviews. It involved no work, since we both regarded him as editorially infallible. We spent a few moments each week on the phone correcting the typesetter’s errors, then moved on to an art he relished as much as film: conversation. That is, he entertained, and I listened. There were stories about meeting Marilyn Monroe in her hotel room, about discovering Walker Percy’s The Moviegoer in the slush pile at Knopf, and about the rigor of Meryl Streep, who attended the Yale School of Drama, but was not, he admitted ruefully, one of his students there. Eventually I was invited to his apartment in the Village for drinks, with my friend and fellow editor, Ann Hulbert. Courtly and mocking, he greeted me with the sentence, “I imagined you as a little old lady with a pencil in her bun.”

Over the years, I learned more. Stanley said he had to work hard to convince Alfred Knopf to publish The Moviegoer, and to give Percy a decent advance. Knopf fired him soon afterward. Meanwhile, A.J. Liebling had just finished The Earl of Louisiana, and happened to read a review of the Percy novel, whose protagonist lived and breathed New Orleans. Liebling bought the book, and recommended it to Jean Stafford–his wife and a National Book Award judge that year. Stanley couldn’t resist gloating when it won the fiction prize. Over countless dinners he gave urbane accounts about these interactions with many of the major writers, directors, playwrights, and actors of the 20th century. He corresponded with T.S. Eliot, and George Bernard Shaw, among others. But he also loved hearing about the lives of his friends, and boasting to others about their more modest accomplishments.

More here.

A Symposium on the Gender Gap in Academia

Citationsnetwork-300x279

Over at the Washington Post's The Monkey Cage, Erik Voeten introduces the symposium (via bookforum's omnivore):

Despite substantial progress, it is irrefutable that a gender gap persists in academia – as it does in many other professions. By 2010, women constituted 40 percent of assistant professors and 30 percent of associate professors but only 19 percent of full professors in the political science profession (source). These figures have gone up steadily but slowly (see here) and it would be tempting to believe that the disappearance of the gender gap is merely a matter of time.

Yet, there are still structural obstacles that stand in the way of full equality. Those range from overt sexism to (more commonly) implicit biases and the fact that men on average still do less than 50 percent of childcare and household tasks. The intense discussions surrounding Anne-Marie’s Slaughter‘s article on work-life balance, Sheryl Sandberg‘s Lean In, and the New York Times article on gender issues at the Harvard Business school illustrate that concerns about gender equality in universities and workplaces are alive and well.

And for good reasons. Women are still more likely to consider dropping out of graduate school. There is ample evidence of persistent implicit biases. For example,psychologists have found that women are described in more communal terms in letters of recommendation and that such communal characteristics negatively affect hiring decisions in academia.

More here. In the symposium:

Explaining the gender gap Jane Mansbridge

How to reduce the gender gap in one (relatively) easy step B.F. Walter

Closing the gender citation gap: Introducing RADS Daniel Maliniak and Ryan Powers

Why it matters that more women present at conferences Sara McLaughlin Mitchell

Student evaluations of teaching are probably biased. Does it matter? Lisa Martin

The gender gap from the gatekeeper’s perspective Rick Wilson

Editors and the gender gap Marijke Breuning

Why is work by women systematically devalued? Brett Ashley Leeds

Gender bias in professional networks and citations David Lake

The gender citations gap: A glass half-full perspective Beth Simmons

Jonathan Franzen’s Love Letter to the Doyen of Jewish Intellectual Vienna

Karl_kraus_100113_620px80

Adam Kirsch in Tablet:

For all its variety, Vienna’s Jewish intelligentsia had one thing in common: They all read Karl Kraus. In his autobiography, Elias Canetti describes how he moved to Vienna as a young man and was immediately told that he had to start reading Kraus’ magazine Die Fackel (“The Torch”) if he wanted to be au courant. Die Fackel was not just edited by Karl Kraus; after a few years, he was its sole contributor, and it became a decades-long virtuoso performance. The best English-language book about Kraus is titled The Anti-Journalist, by Paul Reitter, and Die Fackel can best be considered anti-journalism: journalism that attacked and criticized everyone, including other journalists.

In its pages, Kraus held up for mockery everything he hated about Viennese and Austrian society, which was everything: the government, the military, the law, business, advertising, consumer culture, the theater, literature, and above all, the press. His greatest target was Vienna’s main newspaper, the Neue Freie Presse, which was as authoritative in Austria then as the New York Times is in America today. To Kraus, however, the paper was both linguistically and politically corrupt, and he never tired of pointing out everything from clichéd language to actual cases of influence-peddling. In response, the editor of the Neue Freie Presse made a rule that Kraus’ name was never to be mentioned in its columns.

Kraus was such an influential figure, in such an influential time and place, that his name has come down to us through many channels. Canetti writes about him, as do Walter Benjamin and Gershom Scholem; he figures in a small way in the life of Freud, whom he predictably despised. But the actual substance of Kraus’ work remains curiously ghostly in the English-speaking world. While the whole run of Die Fackel is available online in the original German, only small selections have been translated. And even those are hard to appreciate, because of the intensely topical and critical nature of Kraus’ writing. His work took the form of commentary on local figures, passing scandals, the latest books and newspapers—none of which have even the slightest resonance for a 21st-century American reader. That Kraus exercised an enormous moral and literary authority is beyond doubt, but it’s impossible for us to really feel that authority; we have to take it largely on trust.

That situation is not changed by the appearance of The Kraus Project, the admirable and deeply eccentric new book by Jonathan Franzen.

More here.

Love & Death: Bollywood tackles assisted suicide

Jennifer Hancock in The Humanist:

Hancock2-300x240Suicide is a complex issue. To fully understand the implications of any assisted-suicide policy, we ideally should weigh the pros and cons. The problem is that most of our discussions about it are polarized. We choose a side based on personal or partisan preferences and argue without really engaging in the proper give-and-take that’s required for critical thinking. Likewise, one of the reasons it’s so hard to have a rational conversation about a person seeking help to end their life is that we all have a tendency to want to impose our ideas and our preferences on the actions and decisions of others. Do any of us have the right to second-guess another person’s decision about something as intimate as whether to continue living or not? And yet second-guessing is what we all do.

This brings us to Guzaarish (which in English means “request”). Ethan Mascarenhas (played by Hrithik) is a former magician paralyzed from the neck down as a result of a stage accident. He’s made a new career for himself as a motivational disc jockey, encouraging his listeners not to give up hope. It doesn’t matter your situation, he tells them, live life to the fullest and live life joyously. Indeed, Ethan is a very humanistic character. But on the fourteenth anniversary of his accident, when he calls his lawyer and friend Devyani to request her assistance in obtaining the right to commit suicide, his message comes into question. After a judge rejects Ethan’s petition, Devyani urges him to garner public support through his radio show. His campaign, which he dubs “Project Euthanasia,” becomes a big story. People are shocked and everyone in the country thinks they have the right to weigh in on whether Ethan should be allowed to die or not.

More here.

Delayed aging is better investment than cancer, heart disease research

From KurzweilAI:

SeniorsA new multi-university study shows that research to delay aging and the infirmities of old age would have better population health and economic returns than advances in individual fatal diseases such as cancer or heart disease. With even modest gains in our scientific understanding of how to slow the aging process, an additional 5 percent of adults over the age of 65 would be healthy rather than disabled every year from 2030 to 2060, revealed the study in the October issue of Health Affairs.

Put another way, an investment in delayed aging would mean 11.7 million more healthy adults over the age of 65 in 2060. The analysis, from top scientists at the University of Southern California (USC), Harvard University, Columbia University, the University of Illinois at Chicago and other institutions, assumes research investment leading to a 1.25 percent reduction in the likelihood of age-related diseases. In the U.S., the number of people aged 65 and over is expected to more than double in the next 50 years, from 43 million in 2010 to 106 million in 2060. About 28 percent of the current population over 65 is disabled. “In the last half-century, major life expectancy gains were driven by finding ways to reduce mortality from fatal diseases,” said lead author Dana Goldman, holder of the Leonard D. Schaeffer Director’s Chair at the USC Schaeffer Center for Health Policy and Economics. “But now disabled life expectancy is rising faster than total life expectancy, leaving the number of years that one can expect to live in good health unchanged or diminished. If we can age more slowly, we can delay the onset and progression of many disabling diseases simultaneously.”

More here.

Sunday Poem

Not the Heaven of Raccoons

philosophically and logistically speaking
there are some problems with my theory
of separate heavens for separate people
as my sister pointed out the other night
when we met for coffee after going to
the funeral home

wouldn't it be lonely she wondered

my response involves advanced theories of quantum physics in which the universe is expanding so fast that there are infinite alternate universes created which are almost identical to other universes except that in one universe there might be raccoons up in trees while hound dogs bark underneath them and in another universe the raccoons are in the cornfield feasting while in heaven right next door somebody has plugged a radio into a long extension cord and music from the local radio station has scared the raccoons away and bushels of corn are picked by a woman who loves the feel of the perfect ears in her hands because this is her heaven you see not the heaven of raccoons

by Julie Berry
from The Walnut Cracking Machine

This Is the Average Man’s Body

James Hamblin in The Atlantic:

USA-Frontmanmain_jpgTodd is the most typical of American men. His proportions are based on averages from CDC anthropometric data. As a U.S. male age 30 to 39, his body mass index (BMI) is 29; just one shy of the medical definition of obese. At five-feet-nine-inches tall, his waist is 39 inches. Don't let the hyperrealistic toes fool you; Todd is an avatar. I gave Todd his name, and gave his life a narrative arc, but he is actually the child of graphic artist Nickolay Lamm as part of his Body Measurement Project.

Todd would prefer perfection—or at least something superlative, even if it's bad—to being average. But Todd is perfect only in being average. With this perfection comes the privilege of radical singularity, which is visible in his eyes. Though in his face this reads lonesome, Todd does have three international guyfriends. They met at a convention for people with perfectly average bodies, where each won the award for most average body in their respective country: U.S., Japan, Netherlands, and France. The others' BMIs, based on data from each country's national health centers, are 23.7, 25.2, and 25.6. I named them all Todd, actually, even though it could be confusing, because not everyone's name is a testament to their cultural heritage.

More here.

The Evolutionary Ethics of E. O. Wilson

Whitley Kaufman in The New Atlantis:

Dr_-E_O_-Wilson--006In his new book The Social Conquest of Earth (2012), naturalist E. O. Wilson argues that our best chance at understanding and advancing morality will come when we “explain the origin of religion and morality as special events in the evolutionary history of humanity driven by natural selection.” This is a bold claim, yet a familiar one for Wilson, who has been advocating something like this approach to human morality ever since his landmark 1975 work Sociobiology.

In that book, Wilson provocatively argued that “scientists and humanists should consider together the possibility that the time has come for ethics to be removed temporarily from the hands of the philosophers” and that ethics should instead be “biologicized”: questions once debated seemingly without end by philosophers will be settled by biologists using the same methods by which they have explained digestion, reproduction, and all of the other evolved drives and functions of the body. The unification of science and morality, on Wilson’s count, would be a much-needed revolution for ethics. ut it has also long been one of the desiderata of the Enlightenment project — which has been so successful in fulfilling its promise of advancing our scientific knowledge and our material wellbeing, yet seems to have made so little progress in settling debates over ethics. The consilience of the human and natural sciences that Wilson’s sociobiological project promises would carry on the scientific method’s “unrelenting application of reason” to the field of ethics, and finally begin to establish a stable, wise, and enduring ethical code for the future.

More here.

Jonathan Franzen’s ‘Kraus Project’

13SUBFAWCETT-articleInlineEdmund Fawcett at the NY Times:

Placing Kraus was never easy, least of all for Kraus. Like many educated West European Jews, he favored assimilation, not Zionism. In 1899 he abandoned Judaism and in 1911 joined the Catholic Church, only to abandon that in 1923. His great love was the aristocrat Sidonie Nadherny; when she ended their long liaison, some guessed it was because he was “still a Jew” — a phrase Kraus himself had used satirically to mock veiled hostility to assimilated Jews. More probably she saw too little room for a second person in Kraus’s one-man show.

In making a present-day case for Kraus, Franzen has avoided the easy choice. Rather than a tasty serving of epigrams, he and two scholarly Germanists have chosen a pair of essays from the early 1900s that, Franzen believes, speak powerfully to us now. The first is on Heinrich Heine (1797-1856), who along with Goethe was one of Germany’s most famous 19th-century poets. Kraus aimed to knock Heine off the perch where “progressive” middle-class taste had placed the poet as a domesticated house radical. The second essay championed the sparkling musical farces and unpreachy social comedies of an Austrian actor-playwright, Johann Nestroy (1801-62). In both pieces Kraus attacks cultural pretension, false sentiment, cheap irony and reckless faith in progress, especially the economic and technological kinds.

more here.