I just thought this was an interesting article, though it has nothing to do specifically with PC. It discusses how our hospitals make their decisions to add a drug to their formulary, and the influence a percieved expert might have on this decision. An influence that may be over blown. It uses an example of how this happens with wilderness adventures, when group of novices is led into the wilderness by a perceived expert. And how sometimes that perception may not be accurate, but by the time every one figures that out, it might be too late. As one who has been led on wilderness adventures and as one who has led others on such, I found that example interesting. In addition, as one who is often listening to perceived experts on PC( whether MDs or non MDs), I have further interest in this subject. Some of you might also.
https://jamanetwork.com/journals/jama/fullarticle/2722658?guestaccesskey=ba7b0d7d-7cc5-42d3-a444-f76b0f222acd&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=011819Somebody said...
At a recent pharmacy and therapeutics committee meeting, a highly respected specialist presented a novel hemostatic drug for addition to the formulary. The drug had been shown in a phase 2 trial to significantly reduce anti–factor-Xa activity in healthy volunteers, and a subsequent uncontrolled, open-label trial showed evidence of hemostasis.1,2 The cost of the drug was approximately $25 000 to $50 000 per treatment course. Additionally, due to a potential increase in thrombotic risk, a boxed warning was required by the US Food and Drug Administration (FDA). The specialist acknowledged the shortcomings of the trials and potential risks but advocated for the addition of the drug to the formulary based on the argument that few other options existed. Discussions about the merits of the drug ensued, and after 15 minutes, the committee was asked to vote.
This scenario plays out at pharmacy and therapeutics committees across the country;...........................
less has been written about the psychosocial factors that may bias these decisions at the local or institutional level. In this Viewpoint, we highlight one such factor, the expert halo effect,4 and provide recommendations for how institutional pharmacy and therapeutics committees may reduce the influence of this effect on decision-making.
The expert halo effect, steeped in the psychology of heuristics and characterized by the assumption of infallibility of an assigned expert, has recently been described by the outdoor industry as a contributing factor in many wilderness tragedies.4 For example, an outdoor “expert,” typically identified by being more experienced, more confident, or more vocal, is leading a group of relative novices on an adventure. At some point, conditions turn hazardous, and despite concerns by the novices, the group continues on, with trust that the expert knows best what the group can handle and would not lead them astray. However, the expert may or may not actually have the expertise to make proper decisions for the group, but because the group perceives the expert as having this expertise, the expert is imbued with decision-making authority. Yet by the time the group members realize they have crossed into perilous territory, it is too late. Similarly, in medicine, nonexperts may allow experts to influence and lead them, based on the assumption that experts contain specialized knowledge and experience superior to that of nonexperts..........................................................".