Medicine, like Law, Illustrates the Importance of Biases

Applied insights from cognitive and behavioral psychology aren’t limited to the disciplines of economics or law: those insights can also be applied to the field of medicine.

For example, a new study published in JAMA Internal Medicine finds that physicians who receive free meals from pharmaceutical representatives are more likely to prescribe those drugs promoted by the companies. Though prior studies have shown that large gifts to doctors can sway their prescribing habits, the new study shows that even small gestures can noticeably influence physicians’ behavior.

The report was based on 2013 U.S. government data tracking industry payments to doctors and physicians drug prescriptions paid for by the Medicare Part D drug benefit for the elderly. In particular, the data collected focused on three cardiovascular drugs Crestor (AstraZeneca PLC), Bystolic (Allergan PLC), and Benicar (Daiichi Sankyo Co.) as well as one antidepressant drug: Pristiq (Pfizer Inc.). Researchers found that a doctor who received just one free meal in which Crestor was promoted was, on average, 18% more likely to prescribe the cholesterol-lowering drug over alternatives than those who received no such meal. The effect was even more pronounced for the other drugs: a 52% increase in prescription probability for Benicar, 70% for Bystolic, and 118% for Pristiq. And in most cases, the effect got stronger as the number of free meals went up (the exception was Pristiq whose prescription probability peaked after two meals).

These findings are disturbing and surprising especially given that medical practitioners view themselves as objective scientists whose clinics decisions are guided by evidence and logic – not platters of free food from charming drug representatives.

“I don’t think that there is a doctor out there who thinks, ‘I can be bought for a hero or a slice of pizza,’” said Dr. R Adams Dudley, the lead study author Dr. Dudley pointed out that it’s only human nature to reciprocate when another person extends a benevolent gesture towards you. And clearly, the hungry doctors who were fed by the sales reps felt obliged to hear their sales pitches. The upshot is that despite years of formal education and experience in the field, professionals can still be influenced by something as simple as a free meal. No matter how insulated we think we are from cognitive biases, they still have tremendous power to shape our judgments and decisions.

The consequences are far from trivial. A well-placed gift can improperly influence crucial medical decisions and drastically inflate medical costs given that the four brand-name drugs listed above all have lower-cost generic alternatives, for example, Crestor competes with Pfizer’s.

The first step in inoculating against systematic errors in thinking is to acknowledge that all humans are susceptible to small, seemingly insignificant factors. Given this realization, the next step is to continue more in-depth research in the fields of behavioral and cognitive psychology and apply those findings to the institutional practices of economics, medicine, and – for our purposes – law. Internalizing the principles of psychology allow practitioners to understand how the criminal legal system fails and gives legal theorists and policy makers the tools to repair the institutions supporting it. We may even be able to synthesize all lines of research into a sort of ‘grand unified decision theory’, the purpose of which is to  optimize our apparatus for cognitive reasoning and virtually eliminate all sources of error within our democracy’s systems of adjudication.


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