Thursday, August 29, 2013

If You Tell a Lie in a Forest, and No One Hears, Is It Really a Lie?

I don't know, but good luck finding a forest where no one else can hear you any more. Or see you, on the branch-mounted spycam.

On the Internet, the New Yorker cartoon famously posited, Nobody knows you're a dog.

But now it seems that, while they may not have known it before, sooner or later, your doggy-ness will be outed.

This month's Atlantic has a great short article by Megan Garber on "The Way We Lie Now." She notes that "Technology makes it easier than ever to play fast and loose with the truth -- but easier than ever to get caught."

While no Luddite, I've been concerned that the distance created by the Internet makes it easier to play "fast and loose" with trust. It's hard to lie to a close friend, face to face. It's a lot easier in an email or a Facebook post. Garber has interviewed Cornell professor Jeff Hancock, who has studied dishonesty, and he agrees that "We tend to have an easier time lying ...when we're spatially distant from the people we're interacting with."

Of course, there are lies and lies. "Does this dress make me look fat?" almost begs for a lie. "I'll be there in two minutes" (when you're still 15 minutes away) is categorically different from "Money? What money?" (when you've pilfered the cash register).

But the good news, Garber notes, is that while it's easier than ever to lie, it's also easier than ever to get caught:
More than ever before, our communications leave trails.... Which means that the claims we make about ourselves, from the big to the banal, can, as never before, be cross-referenced against reality. Stuck in traffic? This real-time map suggests otherwise. Never got the e-mail? The sender's read receipt begs to differ. You're 25? That was true, a Google search says -- five years ago.
I was a terrible liar as a child -- "terrible" as in "did it all the time", and "terrible" as in "not very good at it". Eventually, I discovered, as many of us do, that it's easier to tell the truth, mostly because it's easier to remember the truth than to remember which lie you told to whom.

It's nice to know that the Internet's going to back me up on this.

Monday, August 19, 2013

Another "Surprising" Headline about Conflicts of Interest

Today's New York Times has a brief article by Robert Pear with one of the most un-surprising headlines I can remember: "Doctors Who Profit From Radiation Prescribe It More Often, Study Finds".

Well, sure.

That doesn't mean I"m happy about it, of course.

I've written before about how easily humans are swayed, even by a pharmaceutical sales rep's "gimme" pens (full post, here), and about how hard it can be to see a conflict of interest, especially from the inside (full post, here), so I do sympathize... up to a point.

Today's article draws from a July 2013 report from the Government Accounting Office (full report, in .pdf format, here) on the recommendation of doctors for IMRT (Intensity-Modulated Radiation Therapy), a relatively common and costly prostate-cancer treatment.

The bottom line: "Doctors who have a financial interest in radiation treatment centers are much more likely to prescribe such treatments for patients with prostate cancer."

The report stated that,
The number of Medicare prostate cancer... IMRT services performed by self-referring groups increased rapidly, while declining for non-self referring groups from 2006 to 2010.... The growth in services performed by self-referring groups was due entirely to limited specialty groups -- groups comprised of urologists and a small number of other specialties -- rather than multispecialty groups.
The report explains that "self-referral" means that "a provider refers patients to entities in which the provider or the provider's family members have a financial interest", and goes on to explain that the Medicare beneficiaries are generally unaware of the financial connection.

For those of us on the outside, it isn't hard to see the conflict of interest.

But I can understand how easy it might be to overlook from the inside. A group of urologists may purchase the radiation therapy equipment, and honestly believe that their brand-new machine is better than anyone else's in town.

And it's possible that it is.

But wouldn't you want to know that the bills for the machine's use will eventually work their way back to the doctor who recommended that treatment center? (The GAO report recommends that "Congress should consider directing the Secretary of Health and Human Services require providers to disclose their financial interests in IMRT to their patients.")

Disclosure is always a good first step. But it shouldn't be the only step. It's valuable to try to step outside of one's own perspective whenever possible: How will this action look to someone who doesn't know me?

Monday, August 12, 2013

It Take More than Not Doing Wrong to Do Right

We often think of ethics as "doing the right thing". In other words, we think of it as resisting the temptation to do wrong: somebody drops a $20 bill as they're stepping away from a cash register, and, instead of pocketing it quietly ourselves, we call out to the person and return the lost money.

But I've been thinking about the flip side of ethics lately. In one version of the Episcopal Church's communal confession of sin, congregants ask God for forgiveness not only because "we have done those things which we ought not to have done", but also because "we have left undone those things which we ought to have done."

Just the other day, I drove right past an older, heavy-set woman walking slowly up a hill, laden with packages. How hard would it have been for me to stop and offer her a ride? I didn't have anyone else in the car; I wasn't late for any appointment. It would have been easy. And I didn't do it.

I've been thinking about leaving things "undone" since reading an article by Winnie Hu in Friday's New York Times, where she reports about a suit filed by deaf customers against the Astor Place (New York) Starbucks for allegedly discriminating against the deaf. A small group of deaf New Yorkers had been meeting regularly at that coffee shop, and say that "Starbucks workers refused to take some of their orders at these meetings, stared when they signed to each other, complained that they were not buying enough coffee and pastries, and eventually told the group not to come back."

As Hu wrote, "The legal battle has jolted many New Yorkers who have made the ubiquitous coffee shops part of their routine, and served as a reminder that even in a city as tolerant as New York, intolerance can be all too common for some populations."

The lawsuit "seeks to compel the company to conduct sensitivity training for employees and adopt policies to better serve deaf customers". A Starbucks spokeswoman would not comment on the specific litigation, but said that the company "does not agree with the allegations contained in the complaint" and noted that the company already provided sensitivity training for its employees and supported "equality, inclusion, and accessibility" for both employees and customers.

We don't hear a lot (if you'll pardon the expression) about discrimination against the hearing-impaired. Hu quotes a civil rights lawyer who said that "discrimination against the deaf often goes overlooked because it is subtle and sophisticated, and because some deaf  people may be isolated and may not speak up when it happens to them." He added,
It's not like putting up a sign on the door, 'No deaf people allowed." But when deaf people are treated differently than others, it does hurt and it's illegal.

Illegal and unethical aren't always the same, but in this case they certainly run together. I'd like to suggest, however, that it's not enough to "do the right thing". People who are hearing-impaired are already outsiders in a hearing world, just as the blind are in a seeing world. It isn't enough to get out of the way of a blind person being led by her guide dog. How hard is it to ask her if she needs assistance? It's not enough to accept a hand-written request for a super-tall extra-strong four-sugars iced coffee from someone who is deaf; how hard is it to offer a warm smile?

As for me, the next time I see someone to whom I should offer a ride, I'm going to try to remember what I left "undone" the last time. And this time, I want to do the really right thing.