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1.  Investment and repayment in a trust game after ventromedial prefrontal damage 
Although trust and reciprocity are ubiquitous in social exchange, their neurobiological substrate remains largely unknown. Here, we investigated the effect of damage to the ventromedial prefrontal cortex (vmPFC)—a brain region critical for valuing social information—on individuals’ decisions in a trust game and in a risk game. In the trust game, one player, the investor, is endowed with a sum of money, which she can keep or invest. The amount she decides to invest is tripled and sent to the other player, the trustee, who then decides what fraction to return to the investor. In separate runs, ten patients with focal bilateral damage to the vmPFC and control participants made decision while playing in the role of either investor or trustee with different anonymous counterparts in each run. A risk game was also included in which the investor faced exactly the same decisions as in the trust game, but a random device (i.e., a computer), not another player, determined the final payoffs. Results showed that vmPFC patients’ investments were not modulated by the type of opponent player (e.g., human vs. computer) present in the environment. Thus, vmPFC patients showed comparable risk-taking preferences both in social (trust game) and nonsocial (risk game) contexts. In stark contrast, control participants were less willing to take risk and invest when they believed that they were interacting with people than a computer. Furthermore, when acted as trustee, vmPFC patients made lower back transfers toward investors, thereby showing less reciprocity behavior. Taken together, these results indicate that social valuation and emotion subserved by vmPFC have a critical role in trusting and reciprocity decisions. The present findings support the hypothesis that vmPFC damage may impair affective systems specifically designed for mediating social transaction with other individuals.
PMCID: PMC3782646  PMID: 24093013
trust; risk; reciprocity; social valuation; vmPFC; lesion studies
2.  Altruistic punishment in patients with Parkinson's disease with and without impulsive behaviour 
Neuropsychologia  2010;49(1):103-107.
Punishing violators of social norms when there is personal cost is known as altruistic punishment. We tested patients with Parkinson's disease (PD) with and without impulsive-compulsive behaviours (ICBs) and matched control subjects, on and off their regular dopamine replacement therapy on a task, in which the patients decided whether or not to invest a sum of money with a trustee. The sum was then quadrupled and the trustee could decide whether or not to return a portion of the investment. Participants could punish the trustee after they were informed of the trustee's decision. We found that PD patients without ICBs on or off medication punished more often than controls, whereas PD patients with ICBs punished more than controls on medication, but similar to controls off medication. These results suggest a role for dopamine in altruistic punishment decisions in PD patients with impulsive compulsive behaviour.
PMCID: PMC3005080  PMID: 20965203
3.  What if I Get Busted? Deception, Choice, and Decision-Making in Social Interaction 
Deception is an essentially social act, yet little is known about how social consequences affect the decision to deceive. In this study, participants played a computerized game of deception without constraints on whether or when to attempt to deceive their opponent. Participants were questioned by an opponent outside the scanner about their knowledge of the content of a display. Importantly, questions were posed so that, in some conditions, it was possible to be deceptive, while in other conditions it was not. To simulate a realistic interaction, participants could be confronted about their claims by the opponent. This design, therefore, creates a context in which a deceptive participant runs the risk of being punished if their deception is detected. Our results show that participants were slower to give honest than to give deceptive responses when they knew more about the display and could use this knowledge for their own benefit. The condition in which confrontation was not possible was associated with increased activity in subgenual anterior cingulate cortex. The processing of a question which allows a deceptive response was associated with activation in right caudate and inferior frontal gyrus. Our findings suggest the decision to deceive is affected by the potential risk of social confrontation rather than the claim itself.
PMCID: PMC3328780  PMID: 22529772
deception; confrontation; social interaction; decision-making
4.  Unforgettable Ultimatums? Expectation Violations Promote Enhanced Social Memory Following Economic Bargaining 
Recent work in the field of neuroeconomics has examined how people make decisions in interactive settings. However, less is currently known about how these social decisions influence subsequent memory for these interactions. We investigated this question by using functional magnetic resonance imaging to scan participants as they viewed photographs of people they had either recently played an Ultimatum Game with in the role of Responder, or that they had never seen before. Based on previous work that has investigated “cheater detection”, we were interested in whether participants demonstrated a relative enhanced memory for partners that made either fair or unfair proposals. We found no evidence, either behaviorally or neurally, supporting enhanced memory based on the amount of money offered by the Proposer. However, we did find that participants’ initial expectations about the offers they would experience in the game influenced their memory. Participants demonstrated relatively enhanced subjective memory for partners that made proposals that were contradictory to their initial expectations. In addition, we observed two distinct brain systems that were associated with partners that either offered more or less than the participants’ expectations. Viewing pictures of partners that exceeded initial expectations was associated with the bilateral anterior insula, anterior cingulate cortex/premotor area, striatum, and bilateral posterior hippocampi, while viewing partners that offered less than initial expectations was associated with bilateral temporal-parietal junction, right STS, bilateral posterior insula, and precuneus. These results suggest that memory for social interaction may not be guided by a specific cheater detection system, but rather a more general expectation violation system.
PMCID: PMC2769546  PMID: 19876405
neuroeconomics; memory; social; expectation; ultimatum game; cheater detection; neural; decision-making
5.  Does interoceptive awareness affect the ability to regulate unfair treatment by others? 
In this study we aimed to investigate how awareness of bodily responses, referred to as interoceptive awareness, influences decision-making in a social interactive context. Interoceptive awareness is thought to be crucial for adequate regulation of one’s emotions. However, there is a dearth of studies that examine the association between interoceptive awareness and the ability to regulate emotions during interpersonal decision-making. Here, we quantified interoceptive awareness with a heartbeat detection task in which we measured the difference between subjective self-reports and an objective psychophysiological measurement of participant heart rates. Social decision-making was quantified using a two-round Ultimatum Game. Participants were asked to first reject or accept an unfair division of money proposed by a partner. In turn, participants could then make an offer on how to divide an amount of money with the same partner. Participants performed 20 rounds of the two-round Ultimatum Game twice, once during baseline condition and once while asked to reappraise emotional reactions when confronted with unfair offers from partners. Results showed that after reappraisal participants (1) accepted more unfair offers and (2) offered higher return divisions, as compared to baseline. With respect to interoceptive awareness, participants with better heartbeat detection scores tended to report less emotional involvement when they applied reappraisal while playing the Ultimatum Game. However, there was no reliably significant relationship between heartbeat detection and the acceptance of unfair offers. Similarly, heartbeat detection accuracy was not related to return offers made in the second round of the Ultimatum Game or the habitual use of emotion regulation. These preliminary findings suggest that the relationship between interoceptive awareness and behavioral changes due to emotion regulation in a social decision-making context appears to be complex.
PMCID: PMC3843146  PMID: 24348438
interoceptive awareness; decision-making; social; unfairness; regulation; emotion; Ultimatum Game; reappraisal
6.  Reinforcement Learning and Savings Behavior* 
The Journal of finance  2009;64(6):2515-2534.
We show that individual investors over-extrapolate from their personal experience when making savings decisions. Investors who experience particularly rewarding outcomes from saving in their 401(k)—a high average and/or low variance return—increase their 401(k) savings rate more than investors who have less rewarding experiences with saving. This finding is not driven by aggregate time-series shocks, income effects, rational learning about investing skill, investor fixed effects, or time-varying investor-level heterogeneity that is correlated with portfolio allocations to stock, bond, and cash asset classes. We discuss implications for the equity premium puzzle and interventions aimed at improving household financial outcomes.
PMCID: PMC2845178  PMID: 20352013
7.  The Caudate Signals Bad Reputation during Trust Decisions 
PLoS ONE  2013;8(6):e68884.
The ability to initiate and sustain trust is critical to health and well-being. Willingness to trust is in part determined by the reputation of the putative trustee, gained via direct interactions or indirectly through word of mouth. Few studies have examined how the reputation of others is instantiated in the brain during trust decisions. Here we use an event-related functional MRI (fMRI) design to examine what neural signals correspond to experimentally manipulated reputations acquired in direct interactions during trust decisions. We hypothesized that the caudate (dorsal striatum) and putamen (ventral striatum) and amygdala would signal differential reputations during decision-making. Twenty-nine healthy adults underwent fMRI scanning while completing an iterated Trust Game as trusters with three fictive trustee partners who had different tendencies to reciprocate (i.e., likelihood of rewarding the truster), which were learned over multiple exchanges with real-time feedback. We show that the caudate (both left and right) signals reputation during trust decisions, such that caudate is more active to partners with two types of “bad” reputations, either indifferent partners (who reciprocate 50% of the time) or unfair partners (who reciprocate 25% of the time), than to those with “good” reputations (who reciprocate 75% of the time). Further, individual differences in caudate activity related to biases in trusting behavior in the most uncertain situation, i.e. when facing an indifferent partner. We also report on other areas that were activated by reputation at p < 0.05 whole brain corrected. Our findings suggest that the caudate is involved in signaling and integrating reputations gained through experience into trust decisions, demonstrating a neural basis for this key social process.
PMCID: PMC3688684  PMID: 23922638
8.  The Role of Self-Blaming Moral Emotions in Major Depression and Their Impact on Social-Economical Decision Making 
People with major depressive disorder (MDD) are more prone to experiencing moral emotions related to self-blame, such as guilt and shame. DSM-IV-TR recognizes excessive or inappropriate guilt as one of the core symptoms of current MDD, whereas excessive shame is not part of the criteria for MDD. However, previous studies specifically assessing shame suggested its involvement in MDD. In the first part of this review, we will consider literature discussing the role of self-blaming moral emotions in MDD. These self-blaming moral emotions have been purported to influence people when they make social and financial decisions in cognitive studies, particularly those using neuroeconomical paradigms. Such paradigms aim to predict social behavior in activities of daily living, by using important resource tangibles (especially money) in laboratory conditions. Previous literature suggests that guilt promotes altruistic behavior via acting out reparative tendencies, whereas shame reduces altruism by means of increasing social and interpersonal distance. In the second part of this review, we will discuss the potential influence of self-blaming moral emotions on overt behavior in MDD, reviewing clinical and experimental studies in social and financial decision-making, in which guilt, and shame were manipulated. This is not a well-established area in the depression literature, however in this opinion paper we will argue that studies of moral emotions and their impact on behavioral decision-making are of potential importance in the clinical field, by linking specific symptoms of a disorder to a behavioral outcome which may lead to stratification of clinical diagnoses in the future.
PMCID: PMC3670430  PMID: 23750148
guilt; shame; major depressive disorder; neuroeconomics; social-economical decision making; neuroimaging
9.  International trade law, plain packaging and tobacco industry political activity: the Trans-Pacific Partnership 
Tobacco Control  2013;23(1):e1.
Tobacco companies are increasingly turning to trade and investment agreements to challenge measures aimed at reducing tobacco use. This study examines their efforts to influence the Trans-Pacific Partnership (TPP), a major trade and investment agreement which may eventually cover 40% of the world's population; focusing on how these efforts might enhance the industry's power to challenge the introduction of plain packaging. Specifically, the paper discusses the implications for public health regulation of Philip Morris International's interest in using the TPP to: shape the bureaucratic structures and decision-making processes of business regulation at the national level; introduce a higher standard of protection for trademarks than is currently provided under the Agreement on Trade Related Aspects of Intellectual Property Rights; and expand the coverage of Investor-State Dispute Settlement which empowers corporations to litigate directly against governments where they are deemed to be in breach of investment agreements. The large number of countries involved in the TPP underlines its risk to the development of tobacco regulation globally.
PMCID: PMC3888632  PMID: 23788606
Global health; Tobacco industry; Public policy; Packaging and Labelling; Globalisation
10.  Learning to interpret one's own outcome as unjustified amplifies altruistic compensation: a training study 
Interpretational tendencies in ambiguous situations were investigated as causal mechanisms of altruistic compensation. We used a training procedure to induce a tendency to interpret one's own advantages as unjustified. In a subsequent mixed-game, participants had to decide whether to invest their own money to compensate a victim of a norm violation. The amount of one's own resources invested as an altruistic compensation was enhanced after the training procedure compared to controls. These findings suggest that interpretational patterns with regard to injustice determine prosocial behavior. The training procedure offers a potential intervention strategy for enhancing altruistic compensation in bystander situations in which people must invest their own resources to restore justice.
PMCID: PMC3868017  PMID: 24391614
altruistic compensation; prosocial behavior; information processing; interpretational tendency; downward comparison
11.  Decision-Making and Risk Aversion among Depressive Adults 
Depression is associated with behavioral avoidance of potentially rewarding environmental contexts. The present study examined the performance of depressive individuals and controls on a neuropsychological measure of decision-making that favors risk avoidance. Depressive (n = 41) and control (n = 44) participants were administered the Iowa Gambling Task, which measures the ability of participants to maximize earnings by choosing low-risk, low-reward responses over high-risk, high-reward responses. Results provided partial support for the hypothesis that depressive participants would learn to avoid risky responses faster than control participants. Depressive participants demonstrated better performance than controls, scoring higher than controls overall and showing a trend towards earning more money overall. However, the lack of an interaction between depressive status and time does not support the specific hypothesis of more rapid learning. Findings suggested enhanced feedback-based decision making and risk aversion among depressive individuals.
PMCID: PMC2590786  PMID: 18342834
Depression; reward; decision-making; Iowa Gambling Task
12.  Long-Run Savings and Investment Strategy Optimization 
The Scientific World Journal  2014;2014:510531.
We focus on automatic strategies to optimize life cycle savings and investment. Classical optimal savings theory establishes that, given the level of risk aversion, a saver would keep the same relative amount invested in risky assets at any given time. We show that, when optimizing lifecycle investment, performance and risk assessment have to take into account the investor's risk aversion and the maximum amount the investor could lose, simultaneously. When risk aversion and maximum possible loss are considered jointly, an optimal savings strategy is obtained, which follows from constant rather than relative absolute risk aversion. This result is fundamental to prove that if risk aversion and the maximum possible loss are both high, then holding a constant amount invested in the risky asset is optimal for a standard lifetime saving/pension process and outperforms some other simple strategies. Performance comparisons are based on downside risk-adjusted equivalence that is used in our illustration.
PMCID: PMC3953623
13.  The influence of emotion regulation on social interactive decision-making 
Emotion (Washington, D.C.)  2010;10(6):815-821.
Although adequate emotion regulation is considered to be essential in every day life, it is especially important in social interactions. However, the question as to what extent two different regulation strategies are effective in changing decision-making in a consequential socially interactive context remains unanswered. We investigated the effect of expressive suppression and emotional reappraisal on strategic decision-making in a social interactive task, i.e. the Ultimatum Game. As hypothesized, participants in the emotional reappraisal condition accepted unfair offers more often than participants in the suppression and no-regulation condition. Additionally, the effect of emotional reappraisal influenced the amount of money participants proposed during a second interaction with partners that had treated them unfairly in a previous interaction. These results support and extend previous findings that emotional reappraisal as compared to expressive suppression, is a powerful regulation strategy that influences and changes how we interact with others even in the face of inequity.
PMCID: PMC3057682  PMID: 21171756
emotion regulation; decision-making; reappraisal; ultimatum game; social interactions
14.  Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union—part II: an overview of priorities and tactics used to establish a manufacturing presence 
Tobacco Control  2004;13(2):151-160.
Objectives: To explore how British American Tobacco (BAT), having established cigarette imports, responded to the opportunities for investment in cigarette manufacturing in the former Soviet Union (FSU).
Design: Analysis of documents held at the BAT archive in Guildford, UK.
Results: Considerable priority was attached to investing in the FSU. This led BAT to undertake a major organisational change and to intense competition to acquire assets. BAT used flawed economic arguments to persuade cash starved governments that its investment would reap economic rewards. It offered excise advice that disadvantaged governments while benefiting BAT, confused issues over pricing, and avoided competitive tendering. BAT targeted agriculture ministries, using its expertise in leaf production to differentiate itself from other potential investors. It subverted the principles of corporate social responsibility to promote itself as a business partner. BAT's task was made easier by the naivety of post-Soviet governments and by the international financial organisations' support for rapid economic reform. The latter permitted tobacco transnationals to penetrate markets before effective competitive tendering processes had been established, giving them the opportunity to minimise prices and establish monopolies.
Conclusions: Many of the arguments employed when penetrating post-Soviet markets were highly misleading but governments lacked expertise to realise this. There is a need to build tobacco control capacity in transition economies, within and outside government, to ensure that governments are better informed of the true economic and health impacts of tobacco. Rapid transition from socialist to market economies without establishing regulatory institutional structures may be dangerous when investing companies use business practices that fall short of international standards.
PMCID: PMC1747844  PMID: 15175532
15.  An ERP Study on Decisions between Attractive Females and Money 
PLoS ONE  2012;7(10):e45945.
To investigate the neural processes of decision-makings between attractive females and money, we recorded 18 male participants' brain event-related potentials (ERPs) when they performed a novel task of deciding between viewing an attractive female's fuzzy picture in clear and gaining a certain amount of money. Two types of attractive females were included: sexy females and beautiful females. Several new electrophysiological discoveries were obtained as following. First, the beautiful females vs. money task (task B) elicited a larger positive ERP deflection (P2) than the sexy females vs. money task (task S) between 290 and 340 ms, and this probably related to the perception matching process between a visual input and an internal representation or expectation. Second, task S evoked greater negative ERP waves (N2) than task B during the time window of 340–390 ms, and this might relate to response conflict and cognitive monitoring for impulsive tendency. Third, the ERP positivity in task S was larger than task B in the time interval of 550–1000 ms, reflecting that sexy female images may have higher decision value for males than beautiful female images. Fourth, compared with choosing to gain money, choosing to view an attractive female evoked a larger late positive component (LPC) during the same time window, possibly because attractive females are more direct and evolutionarily earlier rewards for males than money amounts.
PMCID: PMC3471902  PMID: 23077499
16.  Eyes are on us, but nobody cares: are eye cues relevant for strong reciprocity? 
Strong reciprocity is characterized by the willingness to altruistically reward cooperative acts and to altruistically punish norm-violating, defecting behaviours. Recent evidence suggests that subtle reputation cues, such as eyes staring at subjects during their choices, may enhance prosocial behaviour. Thus, in principle, strong reciprocity could also be affected by eye cues. We investigate the impact of eye cues on trustees' altruistic behaviour in a trust game and find zero effect. Neither the subjects who are classified as prosocial nor the subjects who are classified as selfish respond to these cues. In sharp contrast to the irrelevance of subtle reputation cues for strong reciprocity, we find a large effect of explicit, pecuniary reputation incentives on the trustees' prosociality. Trustees who can acquire a good reputation that benefits them in future interactions honour trust much more than trustees who cannot build a good reputation. These results cast doubt on hypotheses suggesting that strong reciprocity is easily malleable by implicit reputation cues not backed by explicit reputation incentives.
PMCID: PMC2871936  PMID: 20031986
altruism; strong reciprocity; trust game; cues; reputation
This paper examines the link between affective experience and decision-making performance. In a stock investment simulation, 101 stock investors rated their feelings on an Internet Web site while making investment decisions each day for 20 consecutive business days. Contrary to the popular belief that feelings are generally bad for decision making, we found that individuals who experienced more intense feelings achieved higher decision-making performance. Moreover, individuals who were better able to identify and distinguish among their current feelings achieved higher decision-making performance via their enhanced ability to control the possible biases induced by those feelings.
PMCID: PMC2361392  PMID: 18449361
18.  The development of cooperative relationships: an experiment. 
Pairs of individuals frequently face situations in which they could do well if they cooperated, but each risks being exploited. The Prisoner's Dilemma is widely used for investigating such scenarios, but it is framed in terms of cooperating and defecting, whereas in reality cooperation is rarely "all or nothing". Recent models allowing for variable investment in cooperation indicated the success of a strategy of "raising-the-stakes" (RTS), which invests minimally at first and then increases its investment if its partner matches it. We tested whether this strategy was adopted by subjects participating in an experiment in which they could choose how much money to give to a partner, reciprocity being encouraged by doubling donations. Subjects did increase their donations over successive rounds, both when playing against a stooge who reciprocated with the same investment, and when playing with a partner who was free to choose their investment. Subjects showed a strong tendency to match variations in their partner's investments. Cooperation was therefore achieved through a combination of initial escalation (RTS strategy) and quantitative responsiveness ("give-as-good-as-you-get" strategy). Although initial offers were higher than predicted, our results were broadly consistent with theoretical expectations.
PMCID: PMC1691507  PMID: 14613615
19.  Delay, Probability, and Social Discounting in A Public Goods Game 
A human social discount function measures the value to a person of a reward to another person at a given social distance. Just as delay discounting is a hyperbolic function of delay, and probability discounting is a hyperbolic function of odds-against, social discounting is a hyperbolic function of social distance. Experiment 1 obtained individual social, delay, and probability discount functions for a hypothetical $75 reward; participants also indicated how much of an initial $100 endowment they would contribute to a common investment in a public good. Steepness of discounting correlated, across participants, among all three discount dimensions. However, only social and probability discounting were correlated with the public-good contribution; high public-good contributors were more altruistic and also less risk averse than low contributors. Experiment 2 obtained social discount functions with hypothetical $75 rewards and delay discount functions with hypothetical $1,000 rewards, as well as public-good contributions. The results replicated those of Experiment 1; steepness of the two forms of discounting correlated with each other across participants but only social discounting correlated with the public-good contribution. Most participants in Experiment 2 predicted that the average contribution would be lower than their own contribution.
PMCID: PMC2614818  PMID: 19230512
altruism; self-control; risk-taking; social discounting; delay discounting; probability discounting; public goods game; cooperation; humans
20.  Increasing the amount of payment to research subjects 
Journal of medical ethics  2008;34(9):e14.
This article discusses some ethical issues that can arise when researchers decide to increase the amount of payment offered to research subjects to boost enrollment. Would increasing the amount of payment be unfair to subjects who have already consented to participate in the study? This article considers how five different models of payment—the free market model, the wage payment model, the reimbursement model, the appreciation model, and the fair benefits model—would approach this issue. The article also considers several practical problems related to changing the amount of payment, including determining whether there is enough money in the budget to offer additional payments to subjects who have already enrolled, ascertaining how difficult it will be to re-contact subjects, and developing a plan of action for responding to subjects who find out they are receiving less money and demand an explanation.
PMCID: PMC3966192  PMID: 18757614
21.  Do Executives' Backgrounds Matter to IPO Investors? Evidence from the Life Science Industry 
PLoS ONE  2013;8(5):e60911.
In this study, we focus on the impact of senior executives' industry backgrounds on the amount of capital raised in the stock market. The primary contribution of the study entails applying the upper echelon theory to the initial public offering (IPO) phenomenon. Specifically, we hypothesize that the industry backgrounds of corporate executives affect the amount of capital that the firm raised in the primary stock market. We argue that the firm's future investment strategies are unobserved by the investors ex-ante and investors expect firms' investment strategies to be based on the executives' industry backgrounds. As a result, the executives' industry backgrounds influence the investors' expectations about what investment strategies the firm is likely to deploy. Furthermore, the above logic also suggests that executives of different industry backgrounds should prefer different investment strategies corresponding with demand for different amount of capital. As a result, we expect the industry backgrounds to covary with the capital raised from both the supply and demand perspectives. To test the hypotheses, we ran a reduced econometric model wherein the executives' background predicts the amount of capital raised. Regression analyses suggest that the capital raised is negatively associated with the number of senior executives with prior career experience in the healthcare and genomic sectors but positively associated with the number of senior executives with prior career experience in regulatory affairs. The results provide tentative support for the notion that investors infer corporate strategies from senior executives' industry backgrounds.
PMCID: PMC3655016  PMID: 23690920
22.  A Brief Educational Intervention in Personal Finance for Medical Residents 
Although medical educational debt continues to escalate, residents receive little guidance in financial planning.
To educate interns about long-term investment strategies.
University-based medicine internship program.
Program Description
An unselected cohort of interns (n = 52; 84% of all interns) underwent a 90-minute interactive seminar on personal finance, focusing on retirement savings. Participants completed a preseminar investor literacy test to assess baseline financial knowledge. Afterward, interns rated the seminar and expressed their intention to make changes to their long-term retirement accounts. After 37 interns had attended the seminar, a survey was administered to all interns to compare actual changes to these accounts between seminar attendees and nonattendees.
Measurements and Main Results
Interns’ average score on the investor literacy test was 40%, equal to the general population. Interns strongly agreed that the seminar was valuable (average 5.0 on 5-point Likert scale). Of the 46 respondents to the account allocation survey, interns who had already attended the seminar (n = 25) were more likely than interns who had not yet attended (n = 21) to have switched their investments from low to high-yield accounts at the university hospital (64 vs 19%, P = 0.003) and to enroll in the county hospital retirement plan (64 vs 33%, P = 0.07).
One 90-minute seminar on personal finances leads to significant changes in allocation of tax-deferred retirement savings. We calculate that these changes can lead to substantial long-term financial benefits and suggest that programs consider automatically enrolling trainees into higher yield retirement plans.
PMCID: PMC1824762  PMID: 17356971
curriculum program/evaluation; financial management; medical student and residency education
23.  A Brief Educational Intervention in Personal Finance for Medical Residents 
Although medical educational debt continues to escalate, residents receive little guidance in financial planning.
To educate interns about long-term investment strategies.
University-based medicine internship program.
Program Description
An unselected cohort of interns (n = 52; 84% of all interns) underwent a 90-minute interactive seminar on personal finance, focusing on retirement savings. Participants completed a preseminar investor literacy test to assess baseline financial knowledge. Afterward, interns rated the seminar and expressed their intention to make changes to their long-term retirement accounts. After 37 interns had attended the seminar, a survey was administered to all interns to compare actual changes to these accounts between seminar attendees and nonattendees.
Measurements and Main Results
Interns’ average score on the investor literacy test was 40%, equal to the general population. Interns strongly agreed that the seminar was valuable (average 5.0 on 5-point Likert scale). Of the 46 respondents to the account allocation survey, interns who had already attended the seminar (n = 25) were more likely than interns who had not yet attended (n = 21) to have switched their investments from low to high-yield accounts at the university hospital (64 vs 19%, P = 0.003) and to enroll in the county hospital retirement plan (64 vs 33%, P = 0.07).
One 90-minute seminar on personal finances leads to significant changes in allocation of tax-deferred retirement savings. We calculate that these changes can lead to substantial long-term financial benefits and suggest that programs consider automatically enrolling trainees into higher yield retirement plans.
PMCID: PMC1824762  PMID: 17356971
curriculum program/evaluation; financial management; medical student and residency education
24.  A randomised, controlled trial of a dietary intervention for adults with major depression (the “SMILES” trial): study protocol 
BMC Psychiatry  2013;13:114.
Despite increased investment in its recognition and treatment, depression remains a substantial health and economic burden worldwide. Current treatment strategies generally focus on biological and psychological pathways, largely neglecting the role of lifestyle. There is emerging evidence to suggest that diet and nutrition play an important role in the risk, and the genesis, of depression. However, there are limited data regarding the therapeutic impact of dietary changes on existing mental illness. Using a randomised controlled trial design, we aim to investigate the efficacy and cost-efficacy of a dietary program for the treatment of Major Depressive Episodes (MDE).
One hundred and seventy six eligible participants suffering from current MDE are being randomised into a dietary intervention group or a social support group. Depression status is assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (Non Patient Edition) (SCID-I/NP). The intervention consists of 7 individual nutrition consulting sessions (of approximately 60 minutes), delivered by an Accredited Practising Dietitian (APD). Sessions commence within one week of baseline assessment. The intervention focuses on advocating a healthy diet based on the Australian Dietary Guidelines and the Dietary Guidelines for Adults in Greece. The control condition comprises a befriending protocol using the same visit schedule and length as the diet intervention. The study is being conducted at two locations in Victoria, Australia (a metropolitan and regional centre). Data collection occurs at baseline (pre-intervention), 3-months (post-intervention) and 6– months. The primary endpoint is MADRS scores at 3 months. A cost consequences analysis will determine the economic value of the intervention.
If efficacious, this program could provide an alternative or adjunct treatment strategy for the management of this highly prevalent mental disorder; the benefits of which could extend to the management of common co-morbidities including cardiovascular disease (CVD), obesity, and type 2 diabetes.
Trial registration
PMCID: PMC3636120  PMID: 23587364
Diet; Nutrition; Depression; Mental health; Social support
25.  Neural responses to monetary incentives in major depression 
Biological psychiatry  2007;63(7):686-692.
Reduced responsiveness to positive incentives is a central feature of Major Depressive Disorder (MDD). In the present study, we compared neural correlates of monetary incentive processing in unmedicated depressed participants and never-depressed controls.
Fourteen currently depressed and twelve never-depressed participants underwent fMRI while participating in a monetary incentive delay task. During the task, participants were cued to anticipate and respond to a rapidly presented target in order to gain or avoid losing varying amounts of money.
Depressed and never-depressed participants did not differ in nucleus accumbens (NAcc) activation or in affective or behavioral responses during gain anticipation. Depressed participants did, however, exhibit increasing anterior cingulate activation during anticipation of increasing gains, whereas never-depressed participants showed increasing anterior cingulate activation during anticipation of increasing loss. Depressed subjects also showed reduced discrimination of gain versus nongain outcomes.
The present findings indicate that while unmedicated depressed individuals have the capacity to experience positive arousal and recruit NAcc activation during gain anticipation, they also exhibit increased ACC activation, suggestive of increased conflict during anticipation of gains, in addition to showing reduced discrimination of gain versus nongain outcomes.
PMCID: PMC2290738  PMID: 17916330
reward; depression; incentive; accumbens; prefrontal; cingulate; human; FMRI

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