Conflict of Interest in Medical Research, Education, and Practice (2009) / Chapter Skim
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Appendix D: How Psychological Research Can Inform Policies for Dealing with Conflicts of Interest in Medicine
Appendix D: How Psychological Research Can Inform Policies for Dealing with Conflicts of Interest in Medicine
Pages 358-374
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From page 358... ...
Although the information in this report can be applicable to many types of conflict of interest, it focuses on financial conflicts of interest, which can occur when medical professionals interact with the pharmaceutical industry. For example, when physicians accept support for clinical research or continuing education programs, accept consultantships and appointments to industry-sponsored speakers bureaus, or have informal meetings with pharmaceutical sales representatives who buy lunch and bring drug samples, there is concern about the impact of these relationships on prescribing behaviors and professional responsibilities (Marco et al., 2006)
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From page 359... ...
The section Parallel Evidence in the Medical Literature then provides a brief review that demonstrates the correspondence between the findings from studies of conflicts of interest in the medical field and the findings from basic studies of bias in the field of psychology. The section Implications for Policies Dealing with Medical Conflict of Interest details for policy makers how approaches including educational initiatives, mandatory disclosure, penalties, and limiting the size or type of gifts can be informed by the psychological bias literature.
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From page 360... ...
. This view is also compatible with an orthodox economic approach, which casts succumbing to conflicts of interest as the rational output of a cost-benefit calculation.
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From page 361... ...
addresses this problem through the use of real money incentives without deception and establishes that self-serving interpretations can arise as unwitting and unintentional biases. Simulating pretrial bargaining, Loewenstein et al.
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From page 362... ...
This finding suggests that self-serving biases work by way of distorting the way that people seek out and weigh information when they perceive that they have a stake in the conclusion. The motivated reasoning displayed by the subjects in the study of Loewenstein et al.
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From page 363... ...
" When they evaluate a disagreeable position, people ask, "Must I believe this? " The former question implies a more permissive evidential standard because it requires the decision maker only to seek out confirmatory evidence, whereas the latter question implies that the proposition must survive a search for disconfirming evidence.
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From page 364... ...
The bias blind spot gives us one way of understanding why such strong disagreements can take place over whether conflicts of interest are problematic. In summary, psychological research suggests that people are prone to having optimistic biases about themselves.
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From page 365... ...
Orlowski and Wateska (1992) tracked the pharmacy inventory usage reports for two drugs after the companies producing the drugs sponsored 20 physicians at their institution to attend continuing medical education seminars.
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From page 366... ...
These interventions may be implicitly predicated on the view that succumbing to conflicts of interest is a conscious choice, however, and thus they may have limited or surprising effects if physicians are subject to unconscious bias. The psychological research reviewed here suggests that policy makers may wish to be cautious in their expectations of success for these policies, as they are not tailored to deal with unconscious bias.
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From page 367... ...
research described earlier suggests that simply teaching about biases is more likely to help physicians recognize bias in other physicians than in themselves. The blind spot suggests one reason why many physicians deny that they are personally influenced by gifts from industry, despite evidence that gifts and interactions do influence decision making (e.g., Orlowski and Wateska, 1992; Caudill et al., 1996; Wazana, 2000)
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From page 368... ...
(2006) found that although most physicians had contact with the pharmaceutical industry -- as evidenced by the fact that more than 93 percent of them had received drug samples -- less than two-thirds were aware of the guidelines for interaction with the industry set forth by the college to which the physician belonged, and only one-third were familiar with the guidelines of the American Medical Association.
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From page 369... ...
Although the exaggerated advice may perhaps be discounted, it may still be followed. Decades of psychological research on anchoring and insufficient adjustment has shown that when judgment begins from even a random anchor that people know is incorrect, judgment will not be adjusted sufficiently far from the anchor.
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From page 370... ...
, so that these gifts can also drive up health care costs. Limitations on the size and use of gifts may not be a bad policy in terms of limiting corruption, but there may still be influence associated with gifts that are permitted under many current policies.
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From page 371... ...
mirror the findings from the psychological research on bias suggests that the concept of unconscious bias is a good tool to be used to obtain an understanding of conflicts of interest in medicine. CONCLUSIONS Psychological research tells us that people are prone to having optimistic biases regarding themselves, including judgments about whether their own behavior is objective.
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From page 372... ...
. Do drug samples influence resident prescribing behavior?
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From page 373... ...
. The bias blind spot: Perception of bias in self versus others.
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From page 374... ...
. Physicians and the pharmaceutical industry: Is a gift ever just a gift?
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