Specialty bias

A recurring theme in Doonesbury during the presidency of George W. Bush was that whatever the challenge he was faced with the President would respond by cutting taxes for the wealthy. The reason was not nefarious, according to the comic strip. Cutting taxes was simply what he knew best how to do.

In a column in Sunday’s New York Times Cornell professor Sunita Sah writes of various studies she has conducted showing that disclosure of conflicts of interest can in some instances exacerbate – rather than mitigate – the harmfulness of such conflicts. Most interesting to me in Sah’s article was the interplay of disclosure and the phenomenon of “specialty bias.” She writes:

My latest research, published last month in the Proceedings of the National Academy of Sciences, reveals that patients with localized prostate cancer (a condition that has multiple effective treatment options) who heard their surgeon disclose his or her specialty bias were nearly three times more likely to have surgery than those patients who did not hear their surgeon reveal such a bias. Rather than discounting the surgeon’s recommendation, patients reported increased trust in physicians who disclosed their specialty bias. Remarkably, I found that surgeons who disclosed their bias also behaved differently. They were more biased, not less. These surgeons gave stronger recommendations to have surgery, perhaps in an attempt to overcome any potential discounting they feared their patient would make on the recommendation as a result of the disclosure. Surgeons also gave stronger recommendations to have surgery if they discussed the opportunity for the patient to meet with a radiation oncologist. This aligns with my previous research from randomized experiments, which showed that primary advisers gave more biased advice and felt it was more ethical to do so when they knew that their advisee might seek a second opinion.

Like most behavioral ethics findings, there is logic to this seeming illogic. And for those working in the healthcare field understanding this logic is critically important to minimizing the impact of bias. This logic is presumably also important to understanding bias in the financial advisory world.

Moreover, even for C&E officers not working with companies having COIs involving professional advisors – which differ in various key respects from the types of COIs most frequently found in business organizations generally (such as hiring relatives) – gaining the broader understanding that behavioral ethics offers into how humans function on issues of right and wrong can be invaluable.

In that connection, it is interesting to consider how in many companies C&E officers’ day-to-day work has little to do with addressing biases (other than the few types that can have legal implications – such as racial bias)  or indeed fairness generally. Perhaps this will change if, as the profession matures, the ethics component of C&E becomes better appreciated by business leaders and the government.



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