Natalie Henrich

Markets, religion, community size, and the evolution of fairness and punishment

A Fair Society Many of the social interactions of everyday life, especially those involving economic exchange, take place between individuals who are unrelated to each other and often do not know each other. Countless laboratory experiments have documented the propensity of subjects to behave fairly in these interactions and to punish those participants deemed to have behaved unfairly. Henrich et al. (p. 1480, see the Perspective by Hoff) measured fairness in thousands of individuals from 15 contemporary, small-scale societies to gain an understanding of the evolution of trustworthy exchange among human societies. Fairness was quantitated using three economic games. Various societal parameters, such as the extent to which food was purchased versus produced, were also collected. Institutions, as represented by markets, community size, and adherence to a world religion all predict a greater exercise of fairness in social exchange. The origins of modern social norms and behaviors may be found in the evolution of institutions. Large-scale societies in which strangers regularly engage in mutually beneficial transactions are puzzling. The evolutionary mechanisms associated with kinship and reciprocity, which underpin much of primate sociality, do not readily extend to large unrelated groups. Theory suggests that the evolution of such societies may have required norms and institutions that sustain fairness in ephemeral exchanges. If that is true, then engagement in larger-scale institutions, such as markets and world religions, should be associated with greater fairness, and larger communities should punish unfairness more. Using three behavioral experiments administered across 15 diverse populations, we show that market integration (measured as the percentage of purchased calories) positively covaries with fairness while community size positively covaries with punishment. Participation in a world religion is associated with fairness, although not across all measures. These results suggest that modern prosociality is not solely the product of an innate psychology, but also reflects norms and institutions that have emerged over the course of human history.

More ‘altruistic’ punishment in larger societies

If individuals will cooperate with cooperators, and punish non-cooperators even at a cost to themselves, then this strong reciprocity could minimize the cheating that undermines cooperation. Based upon numerous economic experiments, some have proposed that human cooperation is explained by strong reciprocity and norm enforcement. Second-party punishment is when you punish someone who defected on you; third-party punishment is when you punish someone who defected on someone else. Third-party punishment is an effective way to enforce the norms of strong reciprocity and promote cooperation. Here we present new results that expand on a previous report from a large cross-cultural project. This project has already shown that there is considerable cross-cultural variation in punishment and cooperation. Here we test the hypothesis that population size (and complexity) predicts the level of third-party punishment. Our results show that people in larger, more complex societies engage in significantly more third-party punishment than people in small-scale societies.

What the Public Was Saying about the H1N1 Vaccine: Perceptions and Issues Discussed in On-Line Comments during the 2009 H1N1 Pandemic

During the 2009 H1N1 pandemic, a vaccine was made available to all Canadians. Despite efforts to promote vaccination, the publics intent to vaccinate remained low. In order to better understand the publics resistance to getting vaccinated, this study addressed factors that influenced the publics decision making about uptake. To do this, we used a relatively novel source of qualitative data – comments posted on-line in response to news articles on a particular topic. This study analysed 1,796 comments posted in response to 12 articles dealing with H1N1 vaccine on websites of three major Canadian news sources. Articles were selected based on topic and number of comments. A second objective was to assess the extent to which on-line comments can be used as a reliable data source to capture public attitudes during a health crisis. The following seven themes were mentioned in at least 5% of the comments (% indicates the percentage of comments that included the theme): fear of H1N1 (18.8%); responsibility of media (17.8%); government competency (17.7%); government trustworthiness (10.7%); fear of H1N1 vaccine (8.1%); pharmaceutical companies (7.6%); and personal protective measures (5.8%). It is assumed that the more frequently a theme was mentioned, the more that theme influenced decision making about vaccination. These key themes for the public were often not aligned with the issues and information officials perceived, and conveyed, as relevant in the decision making process. The main themes from the comments were consistent with results from surveys and focus groups addressing similar issues, which suggest that on-line comments do provide a reliable source of qualitative data on attitudes and perceptions of issues that emerge in a health crisis. The insights derived from the comments can contribute to improved communication and policy decisions about vaccination in health crises that incorporate the publics views.

Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea: a qualitative analysis

ObjectivesThe aim of this study is to better understand patients’ perspectives and preferences about treatment with continuous positive airway pressure (CPAP) and oral appliance (OA) devices for obstructive sleep apnea.MethodsThe current study used qualitative analysis of four focus group sessions with current CPAP and OA users. Twenty-two participants with OSA who currently use either CPAP or OA participated in the sessions at the University of British Columbia.ResultsFive topics from the focus group sessions were descriptively analyzed using NVivo software: goals and expectations of treatment, benefits of treatment for bed partners, side effects and inconveniences of CPAP, side effects and inconveniences of OA, and factors impacting treatment choice. In order of most to least frequently mentioned, patients expressed six expectations of treatment: improved health, apnea elimination, improved sleep, reduced fatigue, reduced snoring, and bed-partner benefits. The most to least mentioned factors impacting treatment choice were device effectiveness, transportability, embarrassment, and cost.ConclusionsThis qualitative study showed that many factors impact patients’ experience with their treatment device and that their treatment needs are not only physical but also relate to their lifestyle. This preliminary study provides treatment characteristics and attributes necessary to develop a quantitative questionnaire study, to assist in the selection of therapy, weighing the relative importance of patient and OSA treatment characteristics on treatment preference and adherence. Matching therapy to patient preferences may help identify the most appropriate treatment, and this may achieve greater likelihood of adherence.

Culture does account for variation in game behavior

Lamba and Maces critique (1) of our research (2–4) is based on incorrect claims about our experiments and several misunderstandings of the theory underpinning our efforts. Their findings are consistent with our previous work and lead to no unique conclusions.

Causes of moral distress in the intensive care unit: A qualitative study

PURPOSE The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs. MATERIALS AND METHODS We used focus groups and coding of transcripts into themes and subthemes in 2 tertiary care ICUs and 1 community ICU. RESULTS Based on input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported causes of moral distress were concerns about the care provided by other health care workers, the amount of care provided (especially too much care at end of life), poor communication, inconsistent care plans, and issues around end of life decision making. CONCLUSIONS Causes of moral distress vary among ICU professional groups, but all are amenable to improvement.

De-escalation of therapy for pediatric medulloblastoma: trade-offs between quality of life and survival.

Treatment intensity for pediatric medulloblastoma may vary depending on the type of medulloblastoma. In some cases, the dose of radiation may be reduced or eliminated. Correspondingly, there may be trade‐offs between quality of life and survival. In this study, focus groups were conducted with parents and clinicians to explore their opinions about these trade‐offs as well as the alignment/misalignment between parents and clinicians regarding the trade‐offs.

Communicating During a Pandemic Information the Public Wants About the Disease and New Vaccines and Drugs

To prepare for pandemics, countries are creating pandemic preparedness plans. These plans frequently include crisis communication strategies that recommend conducting pre-crisis audience research to increase the effectiveness and relevance of communication with the public. To begin understanding the communication needs of the public and health care workers, 11 focus groups were conducted in Vancouver, Canada, in 2006 and 2007 to identify what information people want to receive and how they want to receive it. In the event of a pandemic, participants want to know their risk of infection and how sick they could become if infected. To make decisions about using vaccines and drugs, they want information that enables them to assess the risks of using the products. The public prefers to receive this information from family doctors, the Internet, and schools. Health care workers prefer to receive information in e-mails and in-services.

Consequences of Moral Distress in the Intensive Care Unit: A Qualitative Study

Background Moral distress is common among personnel in the intensive care unit, but the consequences of this distress are not well characterized. Objective To examine the consequences of moral distress in personnel in community and tertiary intensive care units in Vancouver, Canada. Methods Data for this study were obtained from focus groups and analysis of transcripts by themes and subthemes in 2 tertiary care intensive care units and 1 community intensive care unit. Results According to input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported emotion associated with moral distress was frustration. Negative impact on patient care due to moral distress was reported 26 times, whereas positive impact on patient care was reported 11 times and no impact on patient care was reported 10 times. Having thoughts about quitting working in the ICU was reported 16 times, and having no thoughts about quitting was reported 14 times. Conclusion In response to moral distress, health care providers experience negative emotional consequences, patient care is perceived to be negatively affected, and nurses and other health care professionals are prone to consider quitting working in the intensive care unit.

BC Medication Management Project: Perspectives of pharmacists, patients and physicians.

Background: The BC Medication Management Project (BCMMP) was developed by the BC Ministry of Health and the BC Pharmacy Association. This pilot project ran from September 2010 to January 2012. Pharmacists reviewed patients’ medication histories, discussed best use of medications, provided education and monitored for adverse effects, developed a plan to deal with medication issues and created a best possible medication history. Methods: To evaluate the experience of participating in the BCMMP, challenges and strengths of the project and the alignment of these experiences with the overarching goals, focus groups and interviews were conducted with 6 stakeholder groups. Themes were compared within and across stakeholder type and descriptively analyzed. Results: A total of 88 people participated in the focus groups/interviews. Pharmacists stated that providing BCMMP services was professionally satisfying and concurred with patients that the service did benefit them. However, participating in the BCMMP was not seen as financially sustainable by pharmacy owners, and there were concerns about patient selection. Physicians expressed concerns about increased workload associated with the BCMMP, for which they were not compensated. The computer system and burden of documentation were identified as the greatest problems. Conclusions: The BCMMP pilot project was enthusiastically received by pharmacists and patients who felt that it benefited patients and moved the pharmacy profession in a positive direction. It was widely felt that the BCMMP could be successful and sustainable if the identified challenges are addressed.