![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 51. Go back in thread:
Posted by Lou Pilder on August 26, 2014, at 13:28:43
In reply to Lou's warning-The Hsiung-Pilder discussion-inkon, posted by Lou Pilder on August 24, 2014, at 11:57:56
> > > My post addressed Bob's liability as someone who blocked or otherwise acted to screen some of the content of users of psychobabble, and the idea that his actions in this role created discomfort that could cause him to need insurance.
> > >
> > > The act says that he has protection for his actions in that role.
> > >
> > > His actions as a creator of content, ie a poster himself, unless he posts in that role of an owner who is monitoring content, would be a different matter. He wouldn't be liable though for giving someone a PBC and stating the reasons for it, for example-- or for sanctioning people in a way that was perceived as unfair.
> > >
> > > I'm not sure what actions of his you find actionable.
> >
> > portormo and friends,
> > It is written here,[...the act says that he has protection...he wouldn't be liable...for sanctioning...in an perceived unfair way...].
> > Now readers, I want you to know that these statements here could not be as accurate as they claim to be by reading what I am about to post here so that you can make a more informed decision as to accepting the poster's clam here or not.
> > The CDA does not give immunity to web site operators such as Mr. Hsiung (and his deputies of record as I will show here) if they develop the content or create it. Some rulings in he US hold the operator liable even if a third party posts it. The question that the high court needs to rule on is as to what is {developing or creating the content} have to have in order for it to be deemed as being created or developed. That question has already been decided in defamation law in the US and I will show you the principles involved to make that determination before CDA/230. And if the high court hears the parallel case, my friend-of-the-court brief will cover that. I am confident that justice Ginsberg could take heed to it and see what is happening here to use in some way for her opinion. This is because of that there are anti-Semitic statements and defamatory statements directed at me by third-party posters being allowed here to be seen where they are originally posted as civil, supportive and will be good for this community as a whole in Mr. Hsiung's thinking and he will not remove or sanction them as I have requested him to do.
> > This brings up the aspect of what is known as vicarious liability known as defamation by {ratification}. In cases before the CDA/230, let us suppose a hypothetical person, Helen Weilz, works at bakery that makes donuts. A coworker scribbles on the wall, "Helen Weilz is bigoted moron". Then Helen goes to the owner, Seymore Hienz, and wants the slogan removed. Seymore refuses and the slogan stays for months on the wall. People come in all day and buy donuts. Helen sues Seymore for {ratification} of the lible. This is all because Seymore knew of the libel and by not removing it effectively ratified the libel, or validated it. Seymore, the bakery owner, said that he was allowing it since he sold donuts, so that it would be good for the company as a hole. Helen sues Seymore for vicarious defamation. The court rules that by Seymore by not removing the defamation, he adopts what it purports as his own.
> > And let us suppose that instead of the slogan, a swastica was drawn on the wall and a Jewish employee asked that it be removed and Seymore refused. And then let us suppose that it came to light that Seymore spray painted the swastika on the wall. Would Seymore be guilty of defamation of the Jews? Or could Seymore justify the allowing of the swastika to remain on the grounds that he did not want those that wanted the swastika to be displayed have their feelings hurt if it was removed? Or could Seymore justify the leaving of the swastika on the wall on the basis that it is "art"?
> > Then there is another principle of defamation where a third party posts it. This I the aspect of what is known as {concert of action} that I will explain in my next post.
> > Lou
> >
> Friends,
> Now let's consider our hypothetical people, Seymore Hienz and Helen Weilz.
> Let us suppose that Helen finds out that the slogan was put on the wall by a group of employees that broke in after hours. And one actually scribbled it on the wall, and another was a lookout, and another stole some donuts and another emptied the cash register. One of the actors goes to Seymore Hienz and confesses that they broke in and did what they did. Now Seymore calls the police, and erases the defamation on the wall. The police confront the others and they all confess. One member says that they only took the donuts, and another says that they did not take the money. And another says that they only broke the lock. And one said that they did nothing but look out the window.
> The question here is:
> A. Are all guilty of the theft of the money?
> B. Are all guilty of the defamation on the wall?
> C. Here Seymore acted on the grounds that he was doing what will be good for that community as a whole. Should he have not called the police on the grounds that the actors would feel bad by being arrested?
> D. Are all of the actors guilty of all of the crimes?
> E. Since the defamation was erased by Seymore, Helen does or does not have a claim for defamation?
> F. Does it matter who ate the donuts?
> Lou
>
> Friends,
Now another hypothetical person enters this situation, Ivan Skidyvan. Ivan is the police officer that Seymore called.
Officer Skidyvan arrests only the person that ate the donuts and allows all the others to be allowed to escape arrest.
A. Would the person that ate the donuts feel discriminated upon?
B. Could that discrimination cause harm to that person?
C. If the person that ate the donuts that was arrested while all the others were allowed to go free, was a person that was vulnerable to feelings of outrage, and taking mind-altering drugs in collaboration with a psychiatrist/doctor, have the potential to kill themselves as a result of the discrimination by officer skidyvan?
D. In court, officer Skidyvan was cross-examined by the person's lawyer that ate the donuts.
Question from lawyer: Why did you arrest this person but not the others?
Officer Skidyvan: I did not want the others to feel bad.
Question from lawyer: Do you practice this all the time?
Officer Skidyvan; I used to apply arrests equally but changed to using selective enforcement of the laws.
Lawyer: What criteria do you use to arrest people now in your selective enforcement of the laws?
Officer Skidyvan: I am not going to tell you that. I do what I think will be good for the community as a whole and please try and trust me in that.
Lawyer: Have you ever been wrong?
Officer Skidyvan:
Yes, many times.
Lawyer: Then what do you do?
Officer Skidyvan; I change the law in my own mind so that I think that I did right even though I did wrong.
Lawyer: How do you know what is right or wrong?
Officer Skidyvan: Since I do what will be good for the community as a whole, there is no right or wrong.
Lawyer: How do you know if by using selective enforcement of the laws it will be good for the community as a whole?
Officer Skidyvan: I don't. I say that because it can not be known if what is done, or not done, will be good for the community as a whole until the future beyond anyone's life span. So in that case that is why I say to trust me.
Lawyer: Do you know who else said what you are saying?
Officer Skidyvan: Yes, and they were able to fool the people for a long time. They even had people trusting them when they committed genocide and slavery and infanticide and discrimination and segregation. They had people believing that it would be good for the community as a whole. They even told the people that they were using the Golden Rule and are being fair.
Lawyer: How could discrimination be fair?
rest
Lou
Posted by Bryte on August 26, 2014, at 22:20:14
In reply to Re: discussion, posted by Dr. Bob on August 26, 2014, at 13:20:56
> > > Can you say more about your interest or concern about whether I have insurance?
> >
> > Yes, I can.
>
> Great, please do.
>
> BobI did.
Now how about you?
Posted by Dr. Bob on August 28, 2014, at 4:05:05
In reply to Re: discussion, posted by Bryte on August 26, 2014, at 22:20:14
> > > > Can you say more about your interest or concern about whether I have insurance?
> > >
> > > Yes, I can.
> >
> > Great, please do.
>
> I did.I must have missed it, can you post a link? Thanks,
Bob
Posted by ClearSkies on August 28, 2014, at 5:13:12
In reply to Re: discussion, posted by Dr. Bob on August 28, 2014, at 4:05:05
> > > > > Can you say more about your interest or concern about whether I have insurance?
> > > >
> > > > Yes, I can.
> > >
> > > Great, please do.
> >
> > I did.
>
> I must have missed it, can you post a link? Thanks,
>
> Bob
>How many times have I seen this tactic used when someone has reached a dead end of a discussion? This is a sign. I only know from obversation and experience.
Carry on.
Posted by Lou Pilder on August 28, 2014, at 9:25:41
In reply to Re: discussion (interjection), posted by ClearSkies on August 28, 2014, at 5:13:12
> > > > > > Can you say more about your interest or concern about whether I have insurance?
> > > > >
> > > > > Yes, I can.
> > > >
> > > > Great, please do.
> > >
> > > I did.
> >
> > I must have missed it, can you post a link? Thanks,
> >
> > Bob
> >
>
> How many times have I seen this tactic used when someone has reached a dead end of a discussion? This is a sign. I only know from obversation and experience.
> Carry on.
>
ClearSkies wrote,[...this tactic used...].
There are many tactics that I can expose here that are being used that IMHHHO could mark the difference between you being a live person or a corpse. This is because when these tactics that I will expose here are used, a subset of readers that are not aware that they are being deceived, could be deceived and be misled which could lead vulnerable people to kill themselves or lead to murder. This is because when a population like this here that are led to believe to take mind-altering drugs in collaboration with a psychiatrist/doctor are misled, they could falsely believe that there is justification for anti-Semitic hate to stand here and what they are doing will be good for their community as a whole. This is seen as that anti-Semitic statements and defamation toward me are allowed to be seen where the are originally posted as civil, supportive and will be good for this community as a whole by a subset of readers.
In deception by evasion, there generally accepted types of evasion which some are:
A. Declining to answer
B. Saying that they are unable or unwilling to answer
C. Deferring the question
D. Pleading ignorance
E. Saying someone else has to answer
When evasion is used, readers could be deceived and misled. This generally happens by the tactic of answering by stating an irrelevant statement that if true, could mislead readers into thinking that what is in question is true also, but that could not be and lead to a false conclusion. And even if it is true, the statement could be irrelevant to what is in question. A classic example is what I showed in an exchange with Phillipa and Mr. Hsiung. There are many more here and if readers that see these tactics like ClearSkies can object here, I think that lives could be saved here.
Lou
Posted by ClearSkies on August 28, 2014, at 11:01:12
In reply to Lou's response-GreytDesptshun » ClearSkies, posted by Lou Pilder on August 28, 2014, at 9:25:41
I am projecting here, to be clear: but I believe it might be a desire to not further pursue a discussion, and nothing more meaningful than that.
Pardon me if I am misconstruing.
ClearSkies
Posted by Lou Pilder on August 28, 2014, at 13:08:06
In reply to Re: Lou's response-GreytDesptshun » Lou Pilder, posted by ClearSkies on August 28, 2014, at 11:01:12
> I am projecting here, to be clear: but I believe it might be a desire to not further pursue a discussion, and nothing more meaningful than that.
>
> Pardon me if I am misconstruing.
> ClearSkiesClearSkies wrote,[...it might be a desire to not further pursue a discussion...].
That is Ok for anyone to have a desire to not pursue a discussion, but for me I want to save lives here and for me to uncover what could mislead you and deceive you needs for me to pursue this discussion.
One of the classic tactics of deceit is to use evasion. To understand how different tactics used in evasion , I want to present examples for readers to use in determining if evasion is being used so they might not be mislead. Let us look at this example and then look at that there are unanswered questions which is the tactic of just not answering that could be seen by a subset of readers as evasion:
Lou
http://www.dr-bob.org/babble/admin/20140304/msgs/1068737.html
Posted by bryte on August 28, 2014, at 23:00:15
In reply to Re: discussion, posted by Dr. Bob on August 28, 2014, at 4:05:05
> > > > > Can you say more about your interest or concern about whether I have insurance?
> > > >
> > > > Yes, I can.
> > >
> > > Great, please do.
> >
> > I did.
>
> I must have missed it, can you post a link? Thanks,
>
> Bob
>
>>>>If guests were attracted to ... the presence of a clinical licensed professional and the relationship proved to be a nuisance because the clinically licensed professional deploys untested techniques that damage the mental tranquility of invitees known to already be at risk, would that comprise an attractive nuisance?http://www.dr-bob.org/babble/admin/20140304/msgs/1069800.html
https://www.google.com/search?q=attractive+nuisance
>>>Section 230 of the Communications Decency Act ... does not shield service providers from liability [for messages] the provider "take[s] responsibility for."www.dr-bob.org/babble/admin/20140304/msgs/1069599.html/msgs/1070152.html
> The poster could feel like I'm throwing a stone at them.>>>Do you select whom you engage in ways that could lead that person to feel you are throwing a stone at them?
>>>Do you have ... a consistent policy for balancing the risk of reinforcement against the advantage of removing a trigger to which you exposed an invitee?
http://www.dr-bob.org/babble/admin/20140304/msgs/1069473.html
>>>Are you saying do not capriciously enforce arbitrary ad hoc rules .... by anybody's definition?>>>Or are you saying that you ... do not knowingly do so?
http://www.dr-bob.org/babble/admin/20140304/msgs/1070152.html
>>>...a common interest in harm reduction... Do you think my concerns are different than your concerns?http://www.dr-bob.org/babble/admin/20140304/msgs/1070108.html
>>>If someone were harmed, would you want to make them or their surviving family whole? Do you believe no harm could result, or that you could in no way be liable [for] harm that results from your activities here?http://www.dr-bob.org/babble/admin/20140304/msgs/1069800.html
Posted by bryte on August 28, 2014, at 23:23:24
In reply to Re: discussion (interjection), posted by ClearSkies on August 28, 2014, at 5:13:12
> > > > > > Can you say more
> How many times have I seen this tactic
"[T]his tactic" could address a broad open ended question that makes only general reference to previously specified concerns.Or, "this tactic" could address a reference to previously described concerns in response to a general open-ended question that does not recognize previously specified concerns.
Even if we presume reference to "this tactic" reveals a bias toward one or the other definition, we cannot count how many times. We cannot count the times because we cannot measure the extent to which observations and experiences in fact revealed signs of the end of a discussion.
Errors in observation can arise from bias and reactivity.
Posted by Dr. Bob on August 28, 2014, at 23:39:33
In reply to Re: discussion, posted by bryte on August 28, 2014, at 23:00:15
> > > > > > Can you say more about your interest or concern about whether I have insurance?
I didn't mean what your concerns were, I meant why you have those concerns, what you hope to accomplish here, etc. Something about you. I-statements.
Bob
Posted by bryte on August 28, 2014, at 23:55:05
In reply to Re: discussion, posted by Dr. Bob on August 28, 2014, at 23:39:33
> > > > > > > Can you say more about your interest or concern about whether I have insurance?
>
> I didn't mean what your concerns were, I meant why you have those concerns, what you hope to accomplish here, etc. Something about you. I-statements.
>
> BobI think my concerns are more about offering support and education than getting some for myself.
Posted by Dr. Bob on August 30, 2014, at 12:39:11
In reply to Re: discussion, posted by bryte on August 28, 2014, at 23:55:05
> I think my concerns are more about offering support and education than getting some for myself.
OK, you're on the altruistic side. That's great. It's always good to have more sources of support and education,
Bob
Posted by bryte on August 30, 2014, at 13:27:42
In reply to Re: discussion, posted by Dr. Bob on August 30, 2014, at 12:39:11
> OK, you're on the altruistic side. That's great. It's always good to have more sources of support and education,
>
> BobInterest in my altruism would be more believable if you would address my concern.
Are you flying without a net, with nothing more than your self-confidence to assure the group that no harm results from the attraction you create?
Posted by pontormo on August 30, 2014, at 21:57:27
In reply to Re: discussion, posted by bryte on August 30, 2014, at 13:27:42
As I recall from my registration, Bob says that he's not directly responsible for posts, and that he doesn't closely monitor and supervise them for either accuracy or wisdom. Plus
there's no suggestion that because a trained mental health professional owns the site, that there's greater protection here for participants. Quite the reverse, I thought.So there is a point at which people assume the risk for things that they do, especially if they're informed that a risk of some sort is involved. So I have always believed that we as posters were assuming some risk by coming here.
I too was wondering why you were so concerned about the issue of insurance and legal liability. i was thinking that usually this would mean that you feel youve observed here that's raised the issue for you. Or that possibly something in your own life makes this particularly important-- since for example and to the contrary I've never even given this a moment's thought.
Posted by bryte on August 30, 2014, at 22:35:29
In reply to Re: discussion, posted by pontormo on August 30, 2014, at 21:57:27
> there's no suggestion that because a trained mental health professional owns the site, that there's greater protection here for participants. Quite the reverse, I thought.
What is "best of both worlds?"
But if it is quite the reverse, my concerns are all the much more relevant.
> I've never even given this a moment's thought.Then either my posts introduce you to new interests, or they do not interest you. I trust some people find these interests important and appreciate an opportunity to consider the matter in a different light.
Posted by pontormo on August 31, 2014, at 0:32:52
In reply to Re: discussion, posted by bryte on August 30, 2014, at 22:35:29
I guess my point in saying that I hadn't thought about it went to the idea that you might have some personal reaction or special concern that you might be willing to communicate.
When I find someone having a puzzling and seemingly somewhat perseverant reaction, it helps if I can see how the reaction might have arisen.
It's not that I don't find the question interesting--- I wouldn't have spent the time I have researching it, if I didn't. But after looking into it, I remain unclear how it would contribute to either my or Bob's sense of security in using or setting up the site.
I may not have considered some element that you see. Or you may have some greater sensitivity to potential harms than I do. Lots of people have left, presumably because it was no longer part of their self-interest or well-being to stay-- most unfortunately. But how would Bob's having insurance have prevented that, or convinced them to be more trusting?
Posted by pontormo on August 31, 2014, at 0:48:59
In reply to Re: discussion, posted by pontormo on August 30, 2014, at 21:57:27
PS Moreover, to clarify: my "quite the reverse"-- I was saying the "IMPRESSION ONE GETS FROM THE REGISTRATION FORM" is quite the reverse from the idea that there is a mental health professional closely monitoring or otherwise assuring the safety of the site for the vulnerable.
Rather one gets the impression that the site is mainly composed of posts from other posters, that while the spirit here is to be civil and there is some oversight of that-- everyone is more or less left to sort it out for themselves.
I was not suggesting that because a mental health professional, was the webmaster, the site was IN FACT any less protective.
Perhaps that was how you had read it?
Posted by bryte on August 31, 2014, at 2:49:29
In reply to Re: discussion, posted by pontormo on August 31, 2014, at 0:32:52
> But how would Bob's having insurance have prevented that, or convinced them to be more trusting?
Insurance demonstrates accountability. Accountability fosters trust.
In so far as Dr. Hsiung wants members to trust his active involvement, communities will inevitably ask him if he is accountable for his actions.
At times, Dr. Hsiung has expressed a desire to trust his community more - perhaps to inspire others to trust the community more. But only he can decide which community he trusts, and how much he will trust the communities of which he is a part.
His community includes graduates of universities trained in various specialties, including experts in actuarial sciences. He has also facilitated establishment of a community that includes a significant proportion of psychologically or mentally at-risk members. Those members often are attracted by the hope of enhancing their efforts to relieve psychological or psychiatric ailments.
Dr. Hsuing at some point added an informed consent procedure to his enrollment process. The procedure alludes to risks involved in participation. The named risks include the potential of receiving bad information, and exposure to sensitive topics.
The risks named in the informed-consent process are foreseeable to the invitee. There may be other, unforeseeable risks. Those can include hazards that result from a premise owner's actions unforeseeable to an invitee.
The named risks do not include a participant's reactions to being told by a doctor it benefits a group to sanction the participant for statements while others who make similar statements do not suffer sanctions. The named risks do not include risks associated with involvement in a research project that is the subject of publications in professional journals without the involvement of a human research protection program.
An HRPP might require a researcher to advise invitees that conversational standards might not be enforced consistently. An HRPP might require notice that a person may suffer reactions caused by inconsistent, public enforcement of standards that place a sole administrator's perceived notion of group benefit ahead of individual's needs - including needs deriving from attachments to the group. An HRPP might advise invitees the group is administered based on one individual's emerging and undocumented sensibilities - sensibilities described as "I know it when I see it."
An insurance policy means experts have assessed risks associated with an activity. It means actuarial scientists, through an insurance agent, have advised the policy holder how much it costs to underwrite indemnity for insured risks.
An insurance policy means the holder cares enough about those who use a service to provide a means to make an invitee or their survivors whole if they suffer harm as a result of hazards associated with an attraction - especially hazards created by the policy holder.
An insurance policy means the holder has contemplated and acknowledged that harm could result from delivery of services the holder offers. An insurance policy means a service providers recognize they cannot competently anticipate every error they might commit that could cause harm or lead to loss of life.
Then the question arises, why do "I" post these concerns? Is it some "...personal reaction or special concern that you might be willing to communicate?"
It is simple compassion. It is a capacity to countenance the suffering of others. Then some might ask, why concern myself with this suffering.
Every day, on average, 10 people in the U.S. die as a result of unintentional, non-boating related drowning. Why would it concern me if I passed by one body of water where one person was drowning?
If I knew waters off of a beach to have a strong undertow and someone was attracting people to that beach but not warning them of the hazard, why would I concern myself with that situation?
Posted by Phillipa on August 31, 2014, at 20:29:06
In reply to Re: discussion, posted by bryte on August 31, 2014, at 2:49:29
Out of curiosity how do you know who the community consists of in professions unless you have been a poster from about the beginning of babble? Phillipa
Posted by pontormo on August 31, 2014, at 21:17:42
In reply to Re: discussion, posted by bryte on August 31, 2014, at 2:49:29
From what I 've read, HRPPs only apply to human research, and from what Bob has said, he's not doing any research on psychobabble now. So that really doesn't apply at the moment. If he were to do research, I'm sure he would go through all the relevant protective procedures, if only because they're required.
But I would think that looking through Bob's bio on the page would be pretty reassuring to anyone who is afraid that Bob doesn't care about the ethics of having an online site. For example he was the Chair of the "Ethical, Legal, and Social Issues Working Group, American Medical Informatics Association" in 2007-8 and President of the International Society for Mental Health Online in 2009 . I just think that his training and the respect that he clearly is held in, would be profoundly reassuring.
Putting that much ti me into thinking about these issues says more about his commitment than just having insurance, which could mostly protect him-- and could just as well suggest that he thinks people will come to harm here and blame him, as much as it could reassure anyone. People take these things in such different ways, that it's not clear that insurance is per se reassuring.
His colleagues have much more information about him than any of us can possibly have-- and their choosing him, as well as his volunteering to do this work, says a lot.
I just find his biosketch incredibly reassuring-- and I hope you've taken at his credentials-- Most people would I think come to have a lot of confidence in him and his judgment and his caring from that.
He himself says that he's not perfect-- that he can only do the best he can do to be fair and make good decisions. That's really all we can ask of anyone. I take him at his word-- and while I've disagreed with decisions, haven't lost the sense that this place is valuable.
But I'm sorry that you don't find it so.
pontormo
Posted by bryte on September 1, 2014, at 1:34:47
In reply to Re: discussion » bryte, posted by Phillipa on August 31, 2014, at 20:29:06
> Out of curiosity how do you know who the community consists of in professions unless you have been a poster from about the beginning of babble? Phillipa
You could be reading reading something into the statement that is not there. It is easy to discern that a medical doctor's professional community includes actuarial scientists. My interest is how much he isolates or includes himself in his professional community.It is obvious that the community of a mental health forum includes mentally or psychologically at risk members.
Maybe you do not understand my post as it was intended it, but those are the communities described.
Posted by bryte on September 1, 2014, at 5:29:42
In reply to Re: discussion, posted by pontormo on August 31, 2014, at 21:17:42
> From what I 've read, HRPPs only apply to human research, and from what Bob has said, he's not doing any research on psychobabble now.
Read more.
"Submitting a message gives me permission to use it as I wish."
http://www.dr-bob.org/babble/admin/20140304/msgs/1068731.html
He failed to mention in the post linked there that he is presenting those research findings - another "case study" as he describes his systematic evaluations - at the XVI World Congress of Psychiatry in Madrid later this month.
In as much as he did not include an HRPP IRB in reviewing his methods and informed consent process, his research presented at XVI WCP might not be acceptable for consideration as research in programs regulated by CFR Title 45 Part 46.
Even if these ongoing publications were mere "case studies" and US HHS exempts case studies, as Dr. Hsiung claims without citing any authority other than CFR 45 part 46.102(d), his conclusion is flawed because quiz answers provided here do not inform participants' capacity to give adequate informed consent to research.
Informed consent at this site requires participants to agree that "The current purpose of this group is: (NOT) to collect research data" but that "Dr. [Robert Hsiung] may publish a case study in an academic journal that includes your message."An IRB might reach a different conclusion, but we do not know because we are not directed in our supposedly informed consent to a related IRB that could tell us what any institutional body concluded. An IRB might conclude that to systematically and repeatedly "publish a case study that includes ... messages" involves systematic collection and evaluation of research data.
An IRB might or might not conclude that such incongruent questions require participants to agree to incongruent conclusions. An IRB might asking mentally disabled individuals to such an incongruent, nuanced offers a promise of group participation as an incentive for consenting to research that could expose them to risks.
An IRB might conclude that the incongruent nuance deliberately or inadvertently selects participants with compromised decision-making capacity, or otherwise forces compromise in decision-making capacity as an initial selector for research compliance. But we do not know, because an IRB has not reviewed the quiz passed off here as informed consent.
>So that really doesn't apply at the moment.
To you. At this moment. Or maybe it does now that you know about his current research. Or non-research citing your involvement to be presented at the World Conference on Psychiatry this month.
Either way, others have different views.
> If he were to do research, I'm sure he would go through all the relevant protective procedures, if only because they're required.
That has not always been the case. It not be the case now. He appears to designate himself the arbiter of what is relevant. Did an HRPP review his use of participants at this website in methods used to reach the conclusion to be presented at XVI WCP that "It is possible to obtain valid informed consent online" -- Implicitly proven possible by using his novel, minimal and unapproved methods?
If it were a case study, and not research, it would present a question - not a conclusion. A case study would ask "is it possible" - not conclude "it is possible."
"Cases are designed to confront readers with specific real-life problems that do not lend themselves to easy answers." http://research-ethics.net/discussion-tools/cases/
You consented, but apparently were misinformed or were not informed that your participation here was currently being used as part of a research method to be presented at the World Congress of Psychiatry that supports a conclusion on the subject of informed consent.The first element of CFR Title 45 informed consent requires: "(1) A statement that the study involves research..."
Dr. Hsiung's purported informed consent requires that we agree with him that his research findings based on evaluation of interaction with us do not comprise research.
To support his claim that the systematic methods he uses to investigate and evaluate subjects including informed consent, online mental health support groups, and reactions to suicide among an online support group are not research, Dr. Hsiung cites CFR 46.102(d):
"Research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. Activities which meet this definition constitute research for purposes of this policy, whether or not they are conducted or supported under a program which is considered research for other purposes. For example, some demonstration and service programs may include research activities."
"(f) Human subject means a living individual about whom an investigator (whether professional or student) conducting research obtains
(1) Data through intervention or interaction with the individual, or
(2) Identifiable private information."
Dr. Hsiung's public admonishments, his conversations with participants that produce statements for ostensibly non-research "case study" publication in peer-reviewed research journals and his collection of quiz answers for presentations at global psychiatric conferences are data collected through intervention and interaction with individual participants. He evaluates data obtained through his interaction with individuals.His collection of e-mail addresses and internet addresses sufficient to intervene when he believes he observes a psychological emergency comprises identifiable private information. Public records created when he utilizes local authorities to respond to perceived emergencies create situations where individuals might not anticipate the limitations of his effort to "protect the privacy of subjects and to maintain the confidentiality of data. @46.111(a)(7)"
46.111(b) says an IRB must be assure that "When some or all of the subjects are likely to be vulnerable to coercion or undue influence, such as children, ... mentally disabled persons, or economically or educationally disadvantaged persons, additional safeguards have been included in the study to protect the rights and welfare of these subjects."
There is no age test here, so children may be involved. We do not know. Where the forum is accessed in Europe, those European participants in Dr. Hsiung's systematic evaluations of "an online self-help group hosted by a mental health professional" may not "discontinue participation at any time without... loss of benefits to which the subject is otherwise entitled. [46.116(a)(8)]" The benefit they lose is the European right to be forgotten because Dr. Hsiung claims a perpetual, irrevocable right to do as he wishes with his human subject's written statements.
Dr. Hsiung's individual impression might be that he is not conducting research when he systematically collects material from human subjects for published case studies. He might individually conclude that it he is not conducting research when he publicizes individual's online statements for which he has required them to relinquish all rights - including Europe's newly recognized right to be forgotten.
But he cites no authority that has approved his conclusion other than a federal regulation that, to an average reader, can appear to contradict his conclusion. Contrary to naming an authoritative panel that supports his conclusion, he represents himself as an expert to peers for the purpose of advancing his conclusion.
> His colleagues have much more information about him than any of us can possibly have-- and their choosing him, as well as his volunteering to do this work, says a lot.
Many a misguided investigator has "volunteered" to try methods independently for which they could not otherwise secure institutional approval.
Publication is a requisite of an academic career. That says something, too. It says a lot that most healthcare providers who offer online health forums choose more typical social network practices that do not so much involve a personal brand and personalized, public admonishment of participants when they offer online support and educational services.
> I just find his biosketch incredibly reassuring-- and I hope you've taken at his credentials-- Most people would I think come to have a lot of confidence in him and his judgment and his caring from that.
>
> He himself says that he's not perfect-- that he can only do the best he can do to be fair and make good decisions. That's really all we can ask of anyone.
If "we" is limited to yourself and those who agree with you, yes. Excluding yourself and those others if you will, we can ask more of people than that they use their own best judgement or that they do what they think is "good.""...the judgment of the investigator is not sufficient as a basis for reaching a conclusion concerning the ethical ...set of questions." -- 1963 NIH Panel that investigated research at the Jewish Chronic Disease Hospital in Brooklyn.
We ask of health research professionals that they rely on the judgement of their community. Most institutions with IRB panels require that the oversight community include actuarial scientists trained to assess risks involved with novel activities that can affect the health of participants. Actuaries are involved when institutions require research projects to be insured. They require insurance in part to protect their institutions against liability arising from research errors. They may require insurance because they consider themselves ethically obligated to indemnify participants for harm.
Title 45 Part 46 requires "(6)For research involving more than minimal risk, an explanation as to whether any compensation and an explanation as to whether any medical treatments are available if injury occurs and, if so, what they consist of, or where further information may be obtained;"
The pre-quiz statement on this site, which subjects might or might not understand before answering 10 multiple-choice questions states "It may be hard to deal with issues like suicide that come up."
Does "more than minimal risk" include contagious psychopathology in a group where suicide is something that can "come up" because the researcher allows and promotes that discussion in public groups for reading by non-enrolled invitees, accessible by search engines and promoted by social-media republication? And who publishes ostensibly non-research case studies about multiple members who have committed suicide, including evaluation of how he manages public discussion of those adverse events among the group?
Title 45 Part 46.102(i) says "Minimal risk means that the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests."
When health research is involved - and especially when the research involves defining informed consent, we can ask more of researchers than that they "...be fair and make good decisions" according to their own discretion.
"Ethical lapses are almost never cases of bad people, doing bad things, for no good reason. Rather, they are good people, doing bad things, for good reasons," says Marcia Angell, MD former Editor-in-Chief, NEJM
Dr. Hsiung will tell the XVI WCP that "Valid informed consent requires assessment of decision-making capacity."
His methods only address decision making capacity of participants. He does not address decision making capacity of the researcher.His methods imply that a capacity of exactly one person might be adequate. CFR Title 45 says otherwise. It says valid informed consent requires the decision making capacity of a compliant IRB. Formal decision making capacity of more than one person is required to determine the sufficiency of informed consent.
As NIH Director James Shannon said in a 1966 statement endorsed by Surgeon General William Steward, "The investigators judgment must be subject to prior peer review to ensure an independent determination of risks and benefits and ...voluntary informed consent,"
Research -- or non-research as we are required to state when we relinquish all rights to content posted here -- that uses methods not reviewed by an IRB cannot reasonably inform the question of whether answers by unidentified participants to unapproved questions demonstrate participants' capacity provide informed consent to a process directed by a lone investigator whose informed consent methodology as not been subject to review.
I believe the hosts' claim of a nuanced claim of a difference between case study and research serves his professional advantage more than it benefits the group as a whole. At best, avoiding IRB review allows him material for professional publication, which is a quid pro quo professional benefit for whatever service he provides here.
I anticipate a greater "probability and magnitude of discomfort anticipated in the research ... greater in and of themselves than those ordinarily encountered in daily life".. for myself and for other participants - especially those who "for how long" have persistently expressed discomfort about inconsistent administration.
To state it succinctly, the adequacy of informed consent must be based upon research to which participants have given informed consent. If participants gave consent to a "case study" that was not research and not subject to IRB review, their agreements do not inform their capacity to give informed consent to research.
>...while I've disagreed with decisions, haven't lost the sense that this place is valuable.
> But I'm sorry that you don't find it so.
>
> pontormo
>There may be little I can do to relieve your sorrow in that regard, but value is not an either-or question.
And now, one more obligatory "I-statement."
In so far as Dr. Hsiung at once invites discussion of his administration and admonishes some invitees who he says might make him feel accused, I consider it inappropriate and unethical for an academic or an investigator to intervene against public discussion of the researcher's ethics in the administration of academic and research processes they conduct with no formal oversight.
As states the Research Ethics Program, UC San Diego in Resources for Research Ethics Education discussion of case studies in the consideration of ethics "unethical behavior is defined by a failure to engage in the process of ethical decision-making. It is always unacceptable to have made no reasonable attempt to define a consistent and defensible basis for conduct."
Posted by pontormo on September 1, 2014, at 12:24:44
In reply to Re: discussion, posted by bryte on September 1, 2014, at 5:29:42
I guess the issues you raise would require a pretty long and detailed (ie footnoted and bibiographed) paper to address.
But I do think on one fundamental, I would disagree with you, which is whether Bob is doing research on "human subjects" as defined by CFR 45 part 46.102(d) and (f).
As the document, and your quote define it,
------(f) Human subject means a living individual about whom an investigator (whether professional or student) conducting research obtains
(1) Data through intervention or interaction with the individual, or
(2) Identifiable private information."To further interpret this, one could add that "definitions" in secton (f), as quoted by you here, explains that:
---
"Intervention includes both physical procedures by which data are gathered (for example, venipuncture) and manipulations of the subject or the subject's environment that are performed for research purposes. Interaction includes communication or interpersonal contact between investigator and subject. "As I wold read it, and as I assume Bob reads it, Bob neither collected data through physical procedures, or manipulation of the subject's environment-- ie we never enter any environment created by Bob, that is being "manipulated" by him-- (ie I don't think Babble constitutes an environment ie place in that sense)-- it would seem that these measures do not apply to what he does here. But you may interpret it differently.
-----
Of course, you make many points, and many of the judgments about these points could be debated-- and, given that neither of us is expert about these, to say the least, or has time, or access to the rulings pertinent to these questions, we can't really make educated arguments about them. At best, we can make naive readings -- not to say that we are not entitled to do so--but we are, again, in the end, forced to decide whether we trust or don't trust Bob's understanding and good faith in subscribing to the requirements of research that legitimately apply and to giving us the protections we are deserving of.
This ultimately is the subtext of our understandings here. I basically trust Bob and you perhaps do not, or at least question reliability or judgment.
Bob did post an announcement of his presentation above on this page, and no one except alexandra responded. So I guess we can assume that no one who reads this page was disturbed by the information. After all, those who read this page could be considered a more concerned or advance minority of gatekeepers for the rest of the community.
But perhaps we should ask Bob to give us a bit more information about his decision-- or to share the text of his study-- so that we can arrive at further conclusions.
Also, I would add that from my conversation with Bob, he never directly contacts anyone or any locality about anyone for whom he has reason to think there is an emergent situation. He regards all identifying information as completely private and inviolable.
But again, perhaps if you queried him privately about your concerns, or perhaps more specifically publicly, he might be able to answer or direct you to answers, that would give you better insight into his thinking.
Posted by 10derheart on September 1, 2014, at 16:59:51
In reply to Re: discussion, posted by pontormo on September 1, 2014, at 12:24:44
>>Also, I would add that from my conversation with Bob, he never directly contacts anyone or any locality about anyone for whom he has reason to think there is an emergent situation.
Well, not literally *direct* contact with the poster, but a "locality" .... I think yes, under certain circumstances only. I understand from my past interactions with him that he might contact a poster's ISP and they in turn might contact the appropriate local authorities with specific location info in the case of a real time suicide attempt (as opposed to ideations or even discussions of specific plans) posted about here.
It seems immoral if a poster writes something like,"Goodbye, Babble, I am going to{insert any place} right now to {fill in a recognized suicide method}," or, "I just swallowed an entire bottle of [blank]," and to then do absolutely nothing to try to help save their life.
I think that well may have happened more than once in the past decade. But, it was a number of years ago and I had second or third hand knowledge, so I can't really say more. I either don't know 100% or can't recall.
Posted by pontormo on September 1, 2014, at 18:04:14
In reply to Re: discussion-**trigger warning** re: suicide » pontormo, posted by 10derheart on September 1, 2014, at 16:59:51
Hi tender--
Thanks for adding that further information.
Bob said that to me also when I met up with him this year in NY.
I got the feeling that he's very committed to the idea that posters here need a strong presumption that their identities will be protected and that therefore he prefers to act by letting ISP webmaster as a free agent- take any further steps.
I too think it would be unfathomable if he didn't take some action if someone were in the process of committing suicide.
But I find it admirable that he doesn't override his concern for the community, as he's said to Lou,-- and it speaks well for his commitment to principle.
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