Wednesday, July 13, 2016

Disclosure and Trust

Lots of people who might give you advice are biased. For example, surgeons are more likely to recommend surgery than other doctors; investment advisers who are paid to recommend certain funds are more likely to recommend them. So you might think that it would be a good idea to require people to disclose all the issues that might bias their advice.

But people are peculiar, and according to Sunita Sah it turns out that sometimes confessing your biases can become a tool for manipulating people into trusting you:
To some extent, they do work. Disclosing a conflict of interest — for example, a financial adviser’s commission or a physician’s referral fee for enrolling patients into clinical trials — often reduces trust in the advice.

But my research has found that people are still more likely to follow this advice because the disclosure creates increased pressure to follow the adviser’s recommendation. It turns out that people don’t want to signal distrust to their adviser or insinuate that the adviser is biased, and they also feel pressure to help satisfy their adviser’s self-interest. Instead of functioning as a warning, disclosure can become a burden on advisees, increasing pressure to take advice they now trust less.

Disclosure can also cause perverse effects even when biases are unavoidable. For example, surgeons are more likely to recommend surgery than non-surgeons. Radiation-oncologists recommend radiation more than other physicians. This is known as specialty bias. Perhaps in an attempt to be transparent, some doctors spontaneously disclose their specialty bias. That is, surgeons may inform their patients that as surgeons, they are biased toward recommending surgery.

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.
Trust no one. Especially not the man who starts by explaining why you shouldn't trust him.

1 comment:

David said...

As a recent recipient of prostate surgery, I suppose I should weigh in on this. I consulted seven physicians: three surgeons, two radiation oncologists, and two medical oncologists (the latter use chemo and hormones to treat cancer). Every single one recommended surgery. I suspect this was because my case was extremely clear-cut based on certain decision-tree-like criteria. Basically, my Gleason score was 7 (6 is the upper limit for "watchful waiting" as an option, even for those who are ardent fans of less aggressive treatment), and I'm under 65 and in reasonable health. That meant surgery. If I were older, in less good health (i. e., if I had a risk factor for surgery like diabetes), or if my Gleason score were different (either lower or a lot higher) the recommendation might have been a little more debatable, and then you might get all sorts of fudging in the name of self-interest.