Comparative Effectiveness Research Not Aligned with Financial Incentives

Four other bottlenecks keep doctors from adopting best practices.

• Ambiguity of study results that hamper decision-making and lead some clinicians to contradictory conclusions.

• Cognitive biases in the interpretation of new information. These include "confirmation bias," the tendency to embrace evidence that confirms preconceived ideas; "pro-intervention bias," the tendency to do something over nothing even if the marginal benefit is small; and the "pro-technology bias," the tendency to believe that newer is better.

"Explaining this phenomenon, one cardiologist told us that by the time of angiography, a patient has become reduced to 'an anatomic appearance on a picture,' implying that the presence of a blockage dwarfs consideration of the relative benefits and harms of the procedure or patient preferences."

• Failure of the research to address the needs of end users, who may be more interested at the start in whether a drug is safe than whether it is effective.

• Limited use of decision support systems by clinicians and patients. The authors wrote that integrating support tools is challenging because clinicians fear spending too much time at their computers than with their patients, and false alerts may trigger too often.