Messy people and algorithms
Think of how hard it is to describe your pain. There are all kinds of pains. How we report it is shaped by how long it lasts, what we think the cause is, where the pain is, how intense it is, and what kind of pain it is (pressing, sharp, radiating), and what relieves it. This is an example of why, for example in treating pain, medicine has been called an art, even though it depends on scientific research.
Having spent a huge portion of my career addressing the challenges of measuring ‘soft’ things in humans like: social support, stress, quality of life, pain, cancer stages, and ordinary feelings, I know well how tough it is to convert these kinds of aspects of our existence into numbers to be used in research and to be fed into algorithms. So many of these depend on our reports rather than ‘objective’ measurements. And some people are more sensitive to pain than others, too.
So I encourage caution as “AI” and Chat-GPT-like algorithms have begun to pervade our medical systems. They can be helpful in many complex diagnostic situations, and interpretation of imaging, but they cannot replace our existing systems of human-to-human communication and the experiences of the patient and physician or nurse.
These bots are efficient and cheap to use, but let us not be deceived into thinking they are better and always worth it. Caution in implementation is required before they become so inextricably woven into medical systems that they push out other approaches. We must continue to challenge them.
Books
Social Support Measurement and Intervention: A Guide for Health and Social ScientistsCohen, S, Underwood, L, Gottlieb, B, eds. Oxford University Press, 2000. This book has become a widely cited resource for the selection and development of ways to figure out how social support affects health and enhance it in people’s lives.
Measuring Stress: A Guide for Health and Social ScientistsCohen, S, Kessler, RC, Underwood-Gordon, L, eds. Oxford University Press, 1997. (and Measuring Stress: A Guide for Health and Social Scientists, Japanese translation, Cohen, S, Kessler, RC, Underwood Gordon, L, eds. Oxford University Press, 1999.) This book provides a foundation for research to identify types and levels of stress and their links to health outcomes, and lays out a variety of ways to measure stress. It was pivotal in the early days of recognizing how stress affects our health and it continues to be widely cited.
Relational Processes and DSM-V: Neuroscience, Assessment, Prevention and Treatment, SRH. Beach, M Wamboldt, N Kaslow, RE.Heyman, MB First, LG Underwood, & D Reiss. eds., American Psychiatric Publishing Inc., 2006. This book was an effort to make sure that relationships with others were included in the DSM-V revision of psychiatric diagnoses. Mental illness does not exist in isolation.
Malignant Melanoma in Northern Ireland, Gordon (Underwood), LG, Queen’s University Press, Belfast, Northern Ireland 1983.
Presentations
Neuroethics, the Arts and the Nature of the Human Person, Medical Humanities Conference, Western Michigan University, Kalamazoo, Michigan, September 29-30 2011.
Visual Art: Insights on the nature of the self in health and disease. Opening of the Gelbke Art Center, Hiram College, February 2008.
What exactly are ‘Good things’–the Outcomes of Interest in Human Research. Public lecture as part of the Bissell Symposium, Hiram College, March 25, 2008.
“The Human Being as revealed more fully in Disability and In Extremis.” European Research Network meeting: The human person in the 21st Century. Thessaloniki, Greece, April 22-25, 2007.
Time and Eternity: An Epidemiological Approach, Conference on “Experimenting: Literature and Science,” Aarhus University, Aarhus, Denmark, May 2002.
World Health Organization Measure of Subjective Quality of Life: Inclusion of values, meaning and spiritual aspects of life: Instrument development and testing, International Society of Quality of Life Research, Amsterdam, Netherlands, November 7, 2001.
Issues in Research at End of Life, Joint Workshop on End of Life Issue, National Institute on Aging, National Institute for Nursing Research, Washington DC, October 22, 2001.
Prevention of Burnout in the Midst of Caring, June 27, 2019 SOAR group, Cleveland, Ohio.
Psychosocial Factors and Health, Psychiatry Grand Rounds, Michigan State University Center for Medical Studies, Kalamazoo, MI, November 2000
Living Well with Disability American Journal of Health Promotion Annual Conference, Amelia Island, FL, March 1999
Improving Health: An Integrative Approach, Grantmakers in Health Annual Meeting, Los Angeles, CA, February 1998.
Biobehavioral Aspects of Pain, Workshop on Biobehavioral Pain Research: A Multi-Agency Assessment of Cross-Cutting Issues and Research Needs, National Institutes of Health, January 18-21, 1994.
Measuring Stress and Integrating the Social Sciences in Asthma Research, Workshop on Stress and Asthma, National Institute of Heart Lung and Blood, NIH, September 27-28, 1993.
“Melanoma Epidemiology”, British Cancer Society, London, England, 1986.
“Cancer Epidemiology – the Role of the Oncogene,” Genetical Society, University of Ulster, Coleraine, Ireland, October 1985.
“Delay in Diagnosis of Cutaneous Malignant Melanoma,” Medical Research Group, Belfast, N. Ireland, May 1985.
“Histopathology of Melanoma in Northern Ireland,” First International Melanoma Meeting, Venice, Italy, May 1985.
Radio Interview
Sun and Skin Cancer, Radio Broadcast, Nationwide – BBC – United Kingdom, June 1986.
Articles
“Crucial considerations for AI implementation with implications for human relationships and recommendations for action.” June 2023 for the US Office of Science and Technology Policy.
“Use of Focus Groups in Multi-Site, Multi-Ethnic Research Projects for Women’s Health: A Study of Women Across the Nation (SWAN) Example” Kagawa-Singer Marjorie, Adler Shelley, Mouton Charles, Ory Marcia, Underwood Lynn G., Ethnicity and Disease (2009), Volume 19, 352-358.
“Measuring Responsiveness in the Therapeutic Relationship: A Patient Perspective” Reis, Harry T., Clark Margaret S., Pereira-Gray Denis J., Tsai Fen-Fang, Brown Judith B., Stewart Moira, and Underwood Lynn G. Basic and Applied Social Psychology, (2008) 30:4,339-348.
“Now bounded, now immeasurable: Perspectives on time in disability, in suffering, and at end of life.” click here to view. Underwood L, Medical Humanities (2007) 33: 11-15.
“Initial steps in developing the World Health Organizations of Quality of Life Instrument (WHOQOL) module for international assessment in HIV/AIDS,” as part of the WHOQOL HIV Group, AIDS CARE (June 2003), Vol 15, No.3, pp.347.WHOQOL HIV Aids Care 2004 copy
“Cross-Cultural Quality of Life Assessment at the End of Life: A Commentary,” Saxena, S., O’Connell, K., Underwood L., The Gerontologist, Vol 42, Special Issue III, October 2002, pg 81-85.
“Physiologic Markers of Chronic Stress in Premenopausal, Middle-Aged Women,” with Powell Lynda H., Lovallo William R., Matthews Karen A., Meyer Peter, Midgley A. Rees, Baum Andrew, Stone, Underwood, Lynn Arthur, McCann J, Janidula Herro Kristi, Ory Marcia, Psychosomatic Medicine (2002) 64:502-509
“Biobehavioral Pain Research: A Multi-Institute Assessment of Cross-Cutting Issues and Research Needs,” Keefe, FJ, Underwood L. Jacobs, M. The Clinical Journal of Pain, 1997:13:91-103.
”Is There a Need to Devise Clinical Trials that do not Depend on Randomized Controlled Testing?” ADVANCES,Vol. 9, No. 2, Spring 1993, 75-79.
“Poor Prognosis for Malignant Melanoma in Northern Ireland: A Multivariate Analysis,” Gordon (Underwood) LG, Lowry, WS, Pedlow, PJ, Patterson, CC. British Journal of Cancer, 1991: 63; 283‑286.
“The Incidence and Pathogenesis of Invasive Cutaneous Malignant Melanoma in Northern Ireland,” Gordon (Underwood) L., Lowry, WS. British Journal of Cancer, 1986:53; 75‑80.
“Missed Malignant Melanomas,” Gordon (Underwood) L., Lowry, WS. British Medical Journal, 986: 292; 1524‑1525
“Cutaneous Malignant Melanoma Tumour Type in Northern Ireland: Possible Aetiological Implications,” Gordon (Underwood) L., Lowry, WS. British Journal of Cancer, 1986: 53; 435.
“Incidence and Aetiology of Melanoma,” Gordon (Underwood) L., Lowry, WS. The Lancet, 1985, i, 8428; 583.
“The Characterization of Melanoma Tumour Type,” Gordon (Underwood) L., Lowry, WS. Irish Journal of Medical Science, 1985: 154 (11) 440.
“A Study of Malignant Melanoma in Northern Ireland,” Gordon (Underwood) and Lowry, WS, Irish Journal of Medical Science, 1982.
“A New Study of Malignant Melanoma,” Gordon (Underwood) L., Lowry, WS. Irish Journal of Medical Science, 1980: 149 (4); 170‑178.
(N.B.: name change from Lynn G. Gordon to Lynn Underwood-Gordon to Lynn G. Underwood)
Chapters
“The Intrinsic Value of Mental Health,” Underwood L. with Ville Lehtinen et al, in , World Health Organization, 2004. (Also available in Mandarin Chinese)
“Strategies for Measuring Stress in Studies of Psychiatric and Physical Disorders,” Cohen, S, Kessler, RC, Underwood LG, in Measuring Stress: A Guide for Health and Social Scientists, Cohen, S, Kessler, RC, Underwood-Gordon, (eds.) Oxford University Press, 1997.
“Social Relationships and Health,” with Cohen, S and Gottlieb, B, in Social Support Measurement and Interventions: A Handbook for Health and Social Scientists, Underwood, L, Cohen, S, Gottlieb, B, (eds.). Oxford University Press, 2000.
“Social Support Measurement and Interventions: Future Directions,” with Karen S. Rook, in Social Support Measurement and Interventions: A Handbook for Health and Social Scientists, Cohen, S, Underwood, L, Gottlieb, B, eds. Oxford University Press, 2000. 311-334.
Classes
Neuroethics. Hiram College 2006-2010 This course covered what neuroscience tells us about what it means to be human and how it affects ethics. And also dealt with the ethical challenges presented by new technological and medical advances in neurology and neuroscience.
Understanding and Interpreting Human Studies. Hiram College 2006-2010. This course dealt with how to evaluate the quality of human studies – medical and social scientific. How to know what to trust, and what implications various studies have for each of us as we make decisions about our health and well-being.
Clinical Trials: Design and Interpretation. 1990-1991. Case Western Reserve University, Cleveland, Department of Epidemiology and Biostatistics, Faculty of Medicine. This course taught how to design a clinical trial and how to interpret the results of published studies.
Looking for and Finding Melanoma. 1983-1986 These classes for medical students, residents and physicians throughout Northern Ireland were designed to enhance ability to diagnose melanoma visually in physical exams.
Other Health Research and Collaborations
Honorary Fellow, Centre for Research into Reading, Information Systems and Linguistics, 2012 to 2016, Institute of Psychology, Health and Society, University of Liverpool. E.g. Help design research on the effectiveness of interventions using reading of fiction and poetry, e.g. on depression and empathic abilities.
St. Louis University School of Medicine, Dept of Ear, Nose and Throat. Designed studies and did statistical data analysis and results write-up. 1989-1992
Study on Psychological Pain Treatments in Children, Case Western University School of Medicine. 1990
Developed multiple interdisciplinaryworking groups and workshops, in areas such as Pain and Suffering, End of Life research, Psychosocial Factors and Asthma, and the nature of Self-Report and facilitated research.
Worked with others to develop a module for the World Health Organization to enrich measures of quality of life to be used in health programs worldwide. Developed a module for HIV-AIDS. Worked with representatives from 18 countries worldwide, from conception and development to translation and implementation. Continues to work on application of this instrument in assessment of quality of life worldwide.
Malignant melanoma research – histopathology and epidemiology and public health – prevention and early detection. 1978-1987.
Principal Investigator: PODARE Leukemia Study, sponsored by the British Government to investigate effects on disease of radioactive effluent into the Irish Sea. Queen’s University School of Medicine, Belfast, N. Ireland, Department of Epidemiology. Concurrent with continuing melanoma work. 1987-1988.