Cognitive Bias and Public Health Policy

July 4, 2020
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JAMA has an article on cognitive bias as it relates to public health policy for COVID-19.

These cognitive errors, which distract leaders from optimal policy making and citizens from taking steps to promote their own and others’ interests, cannot merely be ascribed to repudiations of science. Rather, these biases are pervasive and may have been evolutionarily selected. Even at academic medical centers, where a premium is placed on having science guide policy, COVID-19 action plans prioritized expanding critical care capacity at the outset, and many clinicians treated seriously ill patients with drugs with little evidence of effectiveness, often before these institutions and clinicians enacted strategies to prevent spread of disease.

The article examines four cognitive errors: Identifiable Lives, Optimism Bias, Present Bias, and Omission Bias.

What makes articles like this so interesting is that cognitive biases are generally unknown to the people that hold them. This article is like an attempt to pull back the curtain on hidden influences of what we notice, how we define a problem, how respond to a problem, and how we evaluate that response.

I don’t know whether these biases were at play in COVID policy, this isn’t an empirical matter, but it seems like a credible argument. (We could say that this policy is consistent with that cognitive bias, but we can’t really know the contents of someone else’s mind.)

This got me wondering what cognitive errors are present addiction and recovery treatment and advocacy.

I like this frame because it opens up an exploration of disagreements that gets us away from character and opens the door to the idea that we all operate from cognitive errors that are invisible to us. That being the case, we need others to help us become aware of them.

If this is true–that we all operate from cognitive biases, that they are unknown to us, and we need others to help us see them–then we ought to be thoughtful about how we engage others, right?

  • First of all, a cognitive bias isn’t evidence of bad motives, bad faith, or bad character.
  • Second of all, our field has been big on motivational interviewing with the knowledge that confrontation evokes resistance. We expect each other to integrate this knowledge into our work with with clients, we probably ought to integrate it into our work with each other.
  • Third, if we’re both capable of unknown bias, then the goal should be to examine our thinking to identify any hidden bias. (Of course, I’m focused on your error and want you to see it, but I should be aware that I’m likely to have some of my own.)
  • Finally, if I need people who see things differently to identify my own biases, alienating people who disagree with me or shutting them down is a sure way to perpetuate blindness to my own cognitive errors.

This Lincoln quote comes to mind:

When the conduct of men is designed to be influenced, persuasion, kind, unassuming persuasion, should ever be adopted. It is an old and a true maxim, that a “drop of honey catches more flies than a gallon of gall.” If you would win a man to your cause, first convince him that you are his sincere friend. Therein is a drop of honey that catches his heart, which, say what he will, is the great high road to his reason, and which, when once gained, you will find but little trouble in convincing his judgment of the justice of your cause, if indeed that cause really be a just one. On the contrary, assume to dictate to his judgment, or to command his action, or to mark him as one to be shunned and despised, and he will retreat within himself, close all the avenues to his head and his heart; and tho’ your cause be naked truth itself, transformed to the heaviest lance, harder than steel, and sharper than steel can be made, and tho’ you throw it with more than Herculean force and precision, you shall no more be able to pierce him, than to penetrate the hard shell of a tortoise with a rye straw.

Such is man, and so must he be understood by those who would lead him, even to his own best interest.

Abraham Lincoln speaking to the Washington Temperance Society

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