Evidence for Anchoring Bias During Physician Decision-Making

Ly, D. P., Shekelle, P. G., & Song, Z. (2023).

JAMA Internal Medicine, 183(8), 818.

https://doi.org/10.1001/jamainternmed.2023.2366

Abstract

Introduction

Cognitive biases are hypothesized to influence physician decision-making, but large-scale evidence consistent with their influence is limited. One such bias is anchoring bias, or the focus on a single—often initial—piece of information when making clinical decisions without sufficiently adjusting to later information.

Objective

To examine whether physicians were less likely to test patients with congestive heart failure (CHF) presenting to the emergency department (ED) with shortness of breath (SOB) for pulmonary embolism (PE) when the patient visit reason section, documented in triage before physicians see the patient, mentioned CHF.

Design, Setting, and Participants

In this cross-sectional study of 2011 to 2018 national Veterans Affairs data, patients with CHF presenting with SOB in Veterans Affairs EDs were included in the analysis. Analyses were performed from July 2019 to January 2023.

Conclusions and Relevance

In this cross-sectional study among patients with CHF presenting with SOB, physicians were less likely to test for PE when the patient visit reason that was documented before they saw the patient mentioned CHF. Physicians may anchor on such initial information in decision-making, which in this case was associated with delayed workup and diagnosis of PE.

Here is the conclusion of the paper:

In conclusion, among patients with CHF presenting to the ED with SOB, we find that ED physicians were less likely to test for PE when the initial reason for visit, documented before the physician's evaluation, specifically mentioned CHF. These results are consistent with physicians anchoring on initial information. Presenting physicians with the patient’s general signs and symptoms, rather than specific diagnoses, may mitigate this anchoring. Other interventions include refining knowledge of findings that distinguish between alternative diagnoses for a particular clinical presentation.

Quick snapshot:

Anchoring bias is a cognitive bias that causes us to rely too heavily on the first piece of information we receive when making a decision. This can lead us to make inaccurate or suboptimal decisions, especially when the initial information is not accurate or relevant.

The findings of this study suggest that anchoring bias may be a significant factor in physician decision-making. This could lead to delayed or missed diagnoses, which could have serious consequences for patients.

Delusion-like beliefs and data quality: Are classic cognitive biases artifacts of carelessness?

Sulik, J., Ross, R. M., Balzan, R., & McKay, R. (2023). 

Journal of Psychopathology and Clinical Science.

https://doi.org/10.1037/abn0000844

Abstract

There is widespread agreement that delusions in clinical populations and delusion-like beliefs in the general population are, in part, caused by cognitive biases. Much of the evidence comes from two influential tasks: the Beads Task and the Bias Against Disconfirmatory Evidence Task. However, research using these tasks has been hampered by conceptual and empirical inconsistencies. In an online study, we examined relationships between delusion-like beliefs in the general population and cognitive biases associated with these tasks. Our study had four key strengths: A new animated Beads Task designed to reduce task miscomprehension, several data-quality checks to identify careless responders, a large sample (n = 1,002), and a preregistered analysis plan. When analyzing the full sample, our results replicated classic relationships between cognitive biases and delusion-like beliefs. However, when we removed 82 careless participants from the analyses (8.2% of the sample) we found that many of these relationships were severely diminished and, in some cases, eliminated outright. These results suggest that some (but not all) seemingly well-established relationships between cognitive biases and delusion-like beliefs might be artifacts of careless responding.

General Scientific Summary

Research suggests that cognitive biases play a key role in the development of delusion-like beliefs. For instance, participants who endorse such beliefs have been reported to “jump to conclusions” when performing abstract data-gathering tasks and to display a “bias against disconfirmatory evidence” when determining the best explanation for a scenario. However, the present study suggests that some (but not all) seemingly well-established relationships between cognitive biases and delusion-like beliefs might, in fact, be spurious—driven by careless responding in a subset of research participants.

And my summary:

The study emphasizes the importance of considering data quality in psychological research, particularly when studying biases associated with delusions. By examining whether these biases result from careless data collection or reflect genuine cognitive processes related to delusions, the research aims to enhance our understanding of the validity and reliability of findings in psychology. The findings have the potential to challenge the interpretation of classic cognitive biases and emphasize the need for careful data collection and analysis in order to ensure accurate and reliable research outcomes. Moreover, the research may contribute to improved diagnosis and treatment of delusional disorders by shedding light on the cognitive mechanisms underlying delusion-like beliefs.

A Federal Judge Asks: Does the Supreme Court Realize How Bad It Smells?

Michael Ponsor

The New York Times: Opinion

Originally posted 14 July 23

What has gone wrong with the Supreme Court’s sense of smell?

I joined the federal bench in 1984, some years before any of the justices currently on the Supreme Court. Throughout my career, I have been bound and guided by a written code of conduct, backed by a committee of colleagues I can call on for advice. In fact, I checked with a member of that committee before writing this essay.

A few times in my nearly 40 years on the bench, complaints have been filed against me. This is not uncommon for a federal judge. So far, none have been found to have merit, but all of these complaints have been processed with respect, and I have paid close attention to them.

The Supreme Court has avoided imposing a formal ethical apparatus on itself like the one that applies to all other federal judges. I understand the general concern, in part. A complaint mechanism could become a political tool to paralyze the court or a playground for gadflies. However, a skillfully drafted code could overcome this problem. Even a nonenforceable code that the justices formally pledged to respect would be an improvement on the current void.

Reasonable people may disagree on this. The more important, uncontroversial point is that if there will not be formal ethical constraints on our Supreme Court — or even if there will be — its justices must have functioning noses. They must keep themselves far from any conduct with a dubious aroma, even if it may not breach a formal rule.

The fact is, when you become a judge, stuff happens. Many years ago, as a fairly new federal magistrate judge, I was chatting about our kids with a local attorney I knew only slightly. As our conversation unfolded, he mentioned that he’d been planning to take his 10-year-old to a Red Sox game that weekend but their plan had fallen through. Would I like to use his tickets?

The information is here.

Twitter Exec Defends Restoring Account That Shared Child Sex Abuse Material

Matt Novak

Forbes Magazine

Originally published 9 AUG 23

Executives at X, the company formerly known as Twitter, testified in front of an Australian Parliament hearing late Wednesday, and defended the restoration of an X account after it shared child sexual abuse material in late July. The incident attracted widespread attention because X owner Elon Musk personally intervened to reinstate the account after a violation that would normally result in a permanent ban from the social media platform.

Nick Pickles, the head of global government affairs at X, was asked about the incident by an Australian senator late Wednesday ET, early Thursday Australian local time, after Pickles first suggested there was a zero tolerance policy for child sex abuse material before seeming to contradict himself. Pickles said the offending account in question may have been sharing the content “out of outrage.”

“One of the challenges we see is, for example, people sharing this content out of outrage because they want to raise awareness of an issue and see something in the media,” Pickles testified, according to an audio livestream.

“So if there are circumstances where someone shares content but, under review, we decide the appropriate remediation is to remove the content but not the user,” Pickles continued.

There’s nothing in the X terms of service that says it’s okay to share child sexual abuse material if a user is doing it because they’re outraged over the images or looking to “raise awareness.” It’s generally understood that sharing child sex abuse materials, regardless of intent, is not only a federal crime in the U.S. and Australia, but re-victimizes the child.

The information is here.

The article highlights how this decision contradicts ethical principles and moral standards, as sharing such harmful content not only violates the law but also goes against the norms of safeguarding vulnerable individuals, especially children, from harm. Twitter's move to restore the account in question raises concerns about their commitment to combatting online exploitation and maintaining a safe platform for users.

By reinstating an account associated with child sexual abuse material, Twitter appears to have disregarded the severity of the content and its implications. This decision not only undermines trust in the platform but also reflects poorly on the company's dedication to maintaining a responsible and accountable online environment. Critics argue that Twitter's actions in this case highlight a lack of proper content moderation and an insufficient understanding of the gravity of such unethical behavior.

The article sheds light on the potential consequences of platforms not taking immediate and decisive action against users who engage in illegal and immoral activities. This situation serves as a reminder of the broader challenges social media platforms face in balancing issues of free expression with the responsibility to prevent harm and protect users, particularly those who are most vulnerable.

This article points out the company's total and complete failure to uphold ethical and moral standards.

Artificial intelligence, superefficiency and the end of work: a humanistic perspective on meaning in life

Knell, S., & Rüther, M. (2023). 

AI and Ethics.

https://doi.org/10.1007/s43681-023-00273-w

Abstract

How would it be assessed from an ethical point of view if human wage work were replaced by artificially intelligent systems (AI) in the course of an automation process? An answer to this question has been discussed above all under the aspects of individual well-being and social justice. Although these perspectives are important, in this article, we approach the question from a different perspective: that of leading a meaningful life, as understood in analytical ethics on the basis of the so-called meaning-in-life debate. Our thesis here is that a life without wage work loses specific sources of meaning, but can still be sufficiently meaningful in certain other ways. Our starting point is John Danaher’s claim that ubiquitous automation inevitably leads to an achievement gap. Although we share this diagnosis, we reject his provocative solution according to which game-like virtual realities could be an adequate substitute source of meaning. Subsequently, we outline our own systematic alternative which we regard as a decidedly humanistic perspective. It focuses both on different kinds of social work and on rather passive forms of being related to meaningful contents. Finally, we go into the limits and unresolved points of our argumentation as part of an outlook, but we also try to defend its fundamental persuasiveness against a potential objection.

Concluding remarks

In this article, we explored the question of how we can find meaning in a post-work world. Our answer relies on a critique of John Danaher’s utopia of games and tries to stick to the humanistic idea, namely to the idea that we do not have to alter our human lifeform in an extensive way and also can keep up our orientation towards common ideals, such as working towards the good, the true and the beautiful.

Our proposal still has some shortcomings, which include the following two that we cannot deal with extensively but at least want to briefly comment on. First, we assumed that certain professional fields, especially in the meaning conferring area of the good, cannot be automated, so that the possibility of mini-jobs in these areas can be considered.  This assumption is based on a substantial thesis from the

philosophy of mind, namely that AI systems cannot develop consciousness and consequently also no genuine empathy.  This assumption needs to be further elaborated, especially in view of some forecasts that even the altruistic and philanthropic professions are not immune to the automation of superefficient systems. Second, we have adopted without further critical discussion the premise of the hybrid standard model of a meaningful life according to which meaning conferring objective value is to be found in the three spheres of the true, the good, and the beautiful. We take this premise to be intuitively appealing, but a further elaboration of our argumentation would have to try to figure out, whether this trias is really exhaustive, and if so, due to which underlying more general principle.

A pdf is here.

Full transparency, big John Danaher fan.  Regardless, here is my summary:

Humans are meaning makers. We find meaning in our work, our relationships, and our engagement with the world. The article discusses the potential impact of AI on the meaning of work, and I agree that the authors make some good points. However, I think their solution is somewhat idealistic. It is true that social relationships and engagement with the world can provide us with meaning, but these activities will be difficult to achieve, especially in a world where AI is doing most of the work.  We will need ways to cooperate, achieve, and interact to engage in behaviors that are geared toward super-ordinate goals.  Humans need to align their lives with core human principles, such as meaning-making, pattern repetition, cooperation, and values-based behaviors.

• The authors focus on the potential impact of AI on the meaning of work, but they also acknowledge that other factors, such as automation and globalization, are also having an impact.

• The authors' solution is based on the idea that meaning comes from relationships and engagement with the world. However, there are other theories about the meaning of life, such as the idea that meaning comes from self-actualization or from religious faith.

• The authors acknowledge that their solution is not perfect, but they argue that it is a better alternative than Danaher's solution. However, I think it is important to consider all of the options before deciding which one is best.  Ultimately, it will come down to a values-based decision, as there seems to be no one right or correct solution.

Beyond killing one to save five: Sensitivity to ratio and probability in moral judgment

Ryazanov, A.A., Wang, S.T, et al. (2023).

Journal of Experimental Social Psychology

Volume 108, September 2023, 104499

Abstract

A great deal of current research on moral judgments centers on moral dilemmas concerning tradeoffs between one and five lives. Whether one considers killing one innocent person to save five others to be morally required or impermissible has been taken to determine whether one is appealing to consequentialist or non-consequentialist reasoning. But this focus on tradeoffs between one and five may obscure more nuanced commitments involved in moral decision-making that are revealed when the numbers and ratio of lives to be traded off are varied, and when the probabilities of each outcome occurring are less than certain. Four studies examine participants' reactions to scenarios that diverge in these ways from the standard ones. Study 1 examines the extent to which people are sensitive to the ratio of lives saved to lives ended by a particular action. Study 2 verifies that the ratio rather than the difference between the two values is operative. Study 3 examines whether participants treat probabilistic harm to some as equivalent to certainly harming fewer, holding expected ratio constant. Study 4 explores an analogous issue regarding the sensitivity of probabilistic saving. Participants are remarkably sensitive to expected ratio for probabilistic harms while deviating from expected value for probabilistic saving. Collectively, the studies provide evidence that people's moral judgments are consistent with the principle of threshold deontology.

General discussion

Collectively, our studies show that people are sensitive to expected ratio in moral dilemmas, and that they show this sensitivity across a range of probabilities. The particular kind of sensitivity to expected value participants display is consistent with the view that people's moral judgments are based on one single principle of threshold deontology. If one examines only participants' reactions to a single dilemma with a given ratio, one might naturally tend to sort participants' judgments into consequentialists (the ones who condone killing to save others) or non-consequentialists (the ones who do not). But this can be misleading, as is shown by the result that the number of participants who make judgments consistent with consequentialism in a scenario with ratio of 5:1 decreases when the ratio decreases (as if a larger number of people endorse deontological principles under this lower ratio). The fact that participants make some judgments that are consistent with consequentialism does not entail that these judgments are expressive of a generally consequentialist moral theory. When the larger set of judgments is taken into account, the only theory with which they are consistent is threshold deontology. On this theory, there is a general deontological constraint against killing, but this constraint is overridden when the consequences of inaction are bad enough. The variability across participants suggests that participants have different thresholds of the ratio at which the consequences count as “bad enough” for switching from supporting inaction to supporting action. This is consistent with the wide literature showing that participants' judgments can shift within the same ratio, depending on, for example, how the death of the one is caused.

The research is here.

My summary:

This research provides new insights into how people make moral judgments. It suggests that people are not simply weighing the number of lives saved against the number of lives lost, but that they are also taking into account the ratio of lives saved to lives lost and the probability of each outcome occurring. This research has important implications for our understanding of moral decision-making and for the development of moral education programs.

Teleological thinking is driven by aberrant associations

Corlett, P. R. (2023, June 17).

PsyArXiv preprints

https://doi.org/10.31234/osf.io/wgyqs

Abstract

Teleological thought — the tendency to ascribe purpose to objects and events — is useful in some cases (encouraging explanation-seeking), but harmful in others (fueling delusions and conspiracy theories). What drives maladaptive teleological thinking? A fundamental distinction in how we learn causal relationships between events is whether it can be best explained via associations versus via propositional thought. Here, we propose that directly contrasting the contributions of these two pathways can elucidate where teleological thinking goes wrong. We modified a causal learning task such that we could encourage one pathway over another in different instances. Across experiments (total N=600), teleological tendencies were correlated with delusion-like ideas and uniquely explained by aberrant associative learning, but not by learning via propositional rules. Computational modeling suggested that the relationship between associative learning and teleological thinking can be explained by spurious prediction errors that imbue random events with more significance — providing a new understanding for how humans make meaning of lived events.

From the Discussion section

Teleological thinking, in previous work, has been defined in terms of “beliefs”, “social-cognitive biases”, and indeed carries “reasoning” in its very name (as it is used interchangeably with teleological or ‘purpose-based’ reasoning)—which is why it might be surprising to learn of the relationship between teleological thinking and low-level associative learning, and not learning via propositional reasoning.  The key result across experiments can be summarized as such: aberrant prediction errors augured weaker non-additive blocking, which predicted tendencies to engage in teleological thinking, which was consistently correlated with distress from delusional thinking.  This pattern of results was demonstrated in both behavioral and computational modeling data, and withstood even more conservative regression models, 

accounting for the variance explained by other variables.  In other words, the same people who learn more from irrelevant cues or overpredict relationships in the non-additive blocking task (by predicting that cues [that should have been“blocked”] might also cause allergic reactions) tend to also ascribe more purpose to random events —and to experience more distress from delusional beliefs (and thus hold their delusional beliefs in a more patient-like way).

The research is here.

Some thoughts:

The saying "Life is a projective test" suggests that we all see the world through our own unique lens, shaped by our experiences, beliefs, and values. This lens (read as biases) can cause us to make aberrant associations, or to see patterns and connections that are not actually there.

The authors of the paper found that people who are more likely to engage in teleological thinking are also more likely to make aberrant associations. This suggests that our tendency to see the world in a teleological way may be driven by our own biases and assumptions.

In other words, the way we see the world is not always accurate or objective. It is shaped by our own personal experiences and perspectives. This can lead us to make mistakes, or to see things that are not really there.

The next time you are trying to make sense of something, it is important to be aware of your own biases and assumptions, which may help make better choices. 

How and why people want to be more moral

Sun, J., Wilt, J. A., Meindl, et al. (2023).

Journal of Personality.

https://doi.org/10.1111/jopy.12812

Abstract

Objective

What types of moral improvements do people wish to make? Do they hope to become more good, or less bad? Do they wish to be more caring? More honest? More loyal? And why exactly do they want to become more moral? Presumably, most people want to improve their morality because this would benefit others, but is this in fact their primary motivation? Here, we begin to investigate these questions.

Method

Across two large, preregistered studies (N = 1818), participants provided open-ended descriptions of one change they could make in order to become more moral; they then reported their beliefs about and motives for this change.

Results

In both studies, people most frequently expressed desires to improve their compassion and more often framed their moral improvement goals in terms of amplifying good behaviors than curbing bad ones. The strongest predictor of moral motivation was the extent to which people believed that making the change would have positive consequences for their own well-being.

Conclusions

Together, these studies provide rich descriptive insights into how ordinary people want to be more moral, and show that they are particularly motivated to do so for their own sake.

The research is paywalled here.

My summary:

• People most frequently expressed desires to improve their compassion. This suggests that people are motivated to become more moral in order to be more caring and helpful to others.

• People more often framed their moral improvement goals in terms of amplifying good behaviors than curbing bad ones. This suggests that people are motivated to become more moral by doing more good things, rather than by simply avoiding doing bad things.

• The strongest predictor of moral motivation was the extent to which people believed that making the change would have positive consequences for their own well-being. This suggests that people are motivated to become more moral for their own sake, as well as for the sake of others.

Burnout Is About Your Workplace, Not Your People

Jennifer Moss

Harvard Business Review

Originally posted 11 December 2019

We tend to think of burnout as an individual problem, solvable by “learning to say no,” more yoga, better breathing techniques, practicing resilience — the self-help list goes on. But evidence is mounting that applying personal, band-aid solutions to an epic and rapidly evolving workplace phenomenon may be harming, not helping, the battle. With “burnout” now officially recognized by the World Health Organization (WHO), the responsibility for managing it has shifted away from the individual and towards the organization. Leaders take note: It’s now on you to build a burnout strategy.

The Non-Classification Classification

The term “burnout” originated in the 1970s, and for the past 50 years, the medical community has argued about how to define it. As the debate grows increasingly contentious, the most recent WHO announcement may have caused more confusion than clarity. In May, the WHO included burnout in its International Classification of Diseases (ICD-11) and immediately the public assumed that burnout would now be considered a medical condition. The WHO then put out an urgent clarification stating, “Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon, not a medical condition… reasons for which people contact health services but that are not classed as illnesses or health conditions.”

Although the WHO is now working on guidelines to help organizations with prevention strategies, most still have no idea what to do about burnout. Since it was explicitly not classified as a medical condition, the case is less about liability for employers and more about the impact on employee well-being and the massive associated costs.

The Emotional and Financial Toll

When Stanford researchers looked into how workplace stress affects health costs and mortality in the United States (pdf), they found that it led to spending of nearly $190 billion — roughly 8% of national  healthcare outlays — and nearly 120,000 deaths each year. Worldwide, 615 million suffer from depression and anxiety and, according to a recent WHO study, which costs the global workforce an estimated $1 trillion in lost productivity each year. Passion-driven and caregiving roles such as doctors and nurses  are some of the most susceptible to burnout, and the consequences can mean life or death; suicide rates among caregivers are dramatically higher than that of the general public — 40% higher for men and 130% higher for women.

The info is here.

Summary: Burnout is a serious problem that can have a significant impact on individuals and organizations. It is important to understand that burnout is not just about the individual, but also about the workplace environment. There are a number of factors that can contribute to burnout, including unfair treatment, unmanageable workload, lack of role clarity, lack of communication and support from managers, and unreasonable time pressure.