Blog | Thursday, July 2, 2015

The affect heuristic and conflicts of interest

Understanding the affect heuristic leads one to expand their understanding of the term “conflict of interest”. My simple explanation of the affect heuristic follows:

If you like something, you overestimate the benefits and underestimate the risk. The contrary holds also. If you dislike something, you underestimate the benefits and overestimate the risks.

This concept helps us understand that we should consider multiple conflicts of interest. Clearly the pharmaceutical and device industries have taken advantage of this concept. They hire very likable representatives. These representatives treat physicians very well. Physicians, nurses and office staff like the representatives. Thus, the companies are well considered. When considering a drug that they are selling or a device that they make, the recipients of the kindness attribute benefits and minimize risks for the drug or the device.

The same phenomenon occurs when the business funds research. The recipients of the research funds will have their values changed.

These values change subconsciously. We need not say that the conflict is explicit.

But there are other major conflicts. Our expertise is a conflict. For example, my thoughts about pharyngitis induce the affect heuristic. Being a diabetologist induces the heuristic. Diabetologists overestimate the value of tight control, and suppress the estimates of risks. Interventional cardiologists overestimate the benefits of stenting and underestimate the relative benefits of coronary arty bypass grafting.

Insurance company executives underestimate the benefits of expensive treatments.

The only logical way of avoiding conflicts of interest is to balance our committees and thereby balance the conflicts.

Most guideline writers and performance measurement developers would deny that they have a conflict. But we all have some conflict. We should acknowledge our conflicts and make them explicit.

We cannot avoid conflicts, thus we should consider the competing conflicts.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.