Burton Lee – Ethics, Human Nature, & Scientific Evidence

Dr. Burton Lee is BACK!  It’s always an honor to have Dr. Lee return to the US from Kenya and take a break from his critical care clinical and academic duties across the Atlantic Ocean.  This time, Dr. Lee brought with him another thought provoking lecture about ethics in evidence based medicine and how it may be impacting the way we practice on a day-to-day basis. This talk takes a deeper dive into the scientific literature studying decision making, bias, human nature, and the conflicts that exist within, “Conflict of interest”.

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Concepts

There are only a few sociopaths out there who will lie all the way, and a few who remain completely honest.  A majority fall somewhere in between.

Reciprocity: The act of exchanging something for mutual benefit is a normal behavior (Harvey, 2010), but can have a profound effect on published outcomes, choice of research question, etc.

The Token Effect: The concept that objects gained dishonestly have less of a consequence then if cash is exchanged. (Mazar, 2008) May have a major impact on medical care and medical decision making.

• How often are data points dropped, modified, or changed in scientific research?  It’s actually quite common. (Fanelli, 2009)
• The peer-review process is partially broken, and a soft stop at best (Bohannon, 2013)
• Guidelines seem to be susceptible to bias and conflict of interest as well (Neuman, 2011)

Conflict of Interest

• Moral licensing: Disclosure does not remove bias (Cain (2005) Dirt on Coming Clean)
• Burden of disclosure: The recipient of advice from a biased source, often doesn’t know how to navigate the advice which still has a significant impact on decision making.

The result of these ethical dilemmas is that medical reversals will not be rare.