Nudges, regulations, and behavioral public choice.

Chater & Loewenstein have done a service to the field by raising the fundamental issue of how the political process distorts well-intentioned efforts at behavioral public policy. We connect this argument to broader research on government failure, particularly public choice theory in economics. We further suggest ways that behavioral research can help identify and mitigate such failures.

Conviction Narrative Theory: A theory of choice under radical uncertainty.

Conviction Narrative Theory (CNT) is a theory of choice under radical uncertainty - situations where outcomes cannot be enumerated and probabilities cannot be assigned. Whereas most theories of choice assume that people rely on (potentially biased) probabilistic judgments, such theories cannot account for adaptive decision-making when probabilities cannot be assigned. CNT proposes that people use narratives - structured representations of causal, temporal, analogical, and valence relationships - rather than probabilities, as the currency of thought that unifies our sense-making and decision-making faculties. According to CNT, narratives arise from the interplay between individual cognition and the social environment, with reasoners adopting a narrative that feels "right" to explain the available data; using that narrative to imagine plausible futures; and affectively evaluating those imagined futures to make a choice. Evidence from many areas of the cognitive, behavioral, and social sciences supports this basic model, including lab experiments, interview studies, and econometric analyses. We identify 12 propositions to explain how the mental representations (narratives) interact with four inter-related processes (explanation, simulation, affective evaluation, and communication), examining the theoretical and empirical basis for each. We conclude by discussing how CNT can provide a common vocabulary for researchers studying everyday choices across areas of the decision sciences.

The continued evolution of the ambulatory care pharmacy specialty: Results and analysis from the 2019 Role Delineation Study.

OBJECTIVES: Consistent with certification best practices, update the board-certified ambulatory care pharmacist (BCACP) certification content outline and examination blueprint. METHODS: Qualitative (i.e., focus group) and quantitative (i.e., survey) methods were used to assess, shape, and empirically validate the knowledge, skills, and abilities characterized by the practice performance domain of the BCACP certification content outline and its associated examination blueprint. RESULTS: Survey responses were collected from 434 BCACPs and then reviewed by a representative panel of subject matter experts in ambulatory care pharmacy in addition to psychometric analyses. Using statistical summaries of rating scale data, the panelists recommended revisions to the certification content outline and examination blueprint. Descriptions of how the survey results were used to develop test specifications are also provided. CONCLUSION: This analysis provides validity evidence for the content scope for the BCACP certification and the specifications (i.e., domain weight percentages) of the high-stakes examination. In particular, the study reaffirmed the BCACP examination as a clinically relevant, patient-focused credential, consistent with the BPS mission.

Simplicity and complexity preferences in causal explanation: An opponent heuristic account.

People often prefer simple to complex explanations because they generally have higher prior probability. However, simpler explanations are not always normatively superior because they often do not account for the data as well as complex explanations. How do people negotiate this trade-off between prior probability (favoring simple explanations) and goodness-of-fit (favoring complex explanations)? Here, we argue that people use opponent heuristics to simplify this problem-that people use simplicity as a cue to prior probability but complexity as a cue to goodness-of-fit. Study 1 finds direct evidence for this claim. In subsequent studies, we examine factors that lead one or the other heuristic to predominate in a given context. Studies 2 and 3 find that people have a stronger simplicity preference in deterministic rather than stochastic contexts, while Studies 4 and 5 find that people have a stronger simplicity preference for physical rather than social causal systems, suggesting that people use abstract expectations about causal texture to modulate their explanatory inferences. Together, we argue that these cues and contextual moderators act as powerful constraints that can help to specify the otherwise ill-defined problem of what distributions to use in Bayesian hypothesis comparison.

Exploring the relationship between examination pass rates and eligibility pathways among pharmacist candidates for initial board certification.

OBJECTIVES: To compare examination pass rates among different eligibility cohorts for initial board certification in 6 recognized pharmacy practice specialties. DESIGN: Retrospective observational cohort study. SETTING AND PARTICIPANTS: Practicing U.S. pharmacists who were approved candidates for initial board certification examinations in the following Board of Pharmacy Specialties (BPS)-recognized specialties: ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy. OUTCOME MEASURES: The number and percentage of BPS-approved candidates that pass initial board certification examinations differentiated by specialty and eligibility pathway (i.e., completion of postgraduate residency training or demonstration of postlicensure specialized practice experience). RESULTS: Initial board certification examination outcome (i.e., pass or fail) was assessed for a total of 15,171 candidates from Fall 2015 to Fall 2018. Pass rates for that period based on eligibility pathway (e.g., completion of a PGY-2 specialty residency, completion of a PGY-1 residency plus 1-2 years of postlicensure specialized practice experience, or 3-4 years of postlicensure specialized practice experience) were, respectively as follows: ambulatory care pharmacy (n = 2081): 94%, 84%, and 55% (P < 0.0001); critical care pharmacy (n = 2111): 99%, 94%, and 79% (P < 0.0001); oncology pharmacy (n = 1195) 93%, 75%, and 50% (P < 0.0001); pediatric pharmacy (n = 1119): 87%, 73%, and 57%; (P < 0.0001); pharmacotherapy (n = 8368): 88%, 59% (P < 0.0001); and psychiatric pharmacy (n = 477): 93%, 72%, 49% (P < 0.0001). CONCLUSION: From 2015 to 2018, the percentage of BPS-approved candidates that passed initial board certification examinations in ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy was significantly higher for cohorts deemed to be board eligible based on completion of postgraduate residency training.

Preferences for Explanation Generality Develop Early in Biology But Not Physics.

One of the core functions of explanation is to support prediction and generalization. However, some explanations license a broader range of predictions than others. For instance, an explanation about biology could be presented as applying to a specific case (e.g., "this bear") or more generally across "all animals." The current study investigated how 5- to 7-year-olds (N = 36), 11- to 13-year-olds (N = 34), and adults (N = 79) evaluate explanations at varying levels of generality in biology and physics. Findings revealed that even the youngest children preferred general explanations in biology. However, only older children and adults preferred explanation generality in physics. Findings are discussed in light of differences in our intuitions about biological and physical principles.

Financial alchemists and financial shamans.

Professional money management appears to require little skill, yet its practitioners command astronomical salaries. Singh's theory of shamanism provides one possible explanation: Financial professionals are the shamans of the global economy. They cultivate the perception of superhuman traits, maintain grueling initiation rituals, and rely on esoteric divination rituals. An anthropological view of markets can usefully supplement economic and psychological approaches.

Why do people believe in a zero-sum economy?

Zero-sum thinking and aversion to trade pervade our society, yet fly in the face of everyday experience and the consensus of economists. Boyer & Petersen's (B&P's) evolutionary model invokes coalitional psychology to explain these puzzling intuitions. I raise several empirical challenges to this explanation, proposing two alternative mechanisms - intuitive mercantilism (assigning value to money rather than goods) and errors in perspective-taking.

Little Bayesians or little Einsteins? Probability and explanatory virtue in children's inferences.

Like scientists, children seek ways to explain causal systems in the world. But are children scientists in the strict Bayesian tradition of maximizing posterior probability? Or do they attend to other explanatory considerations, as laypeople and scientists - such as Einstein - do? Four experiments support the latter possibility. In particular, we demonstrate in four experiments that 4- to 8-year-old children, like adults, have a robust latent scope bias that leads to inferences that do not maximize posterior probability. When faced with two explanations equally consistent with observed data, where one explanation makes an unverified prediction, children consistently preferred the explanation that does not make this prediction (Experiment 1), even if the prior probabilities are identical (Experiment 3). Additional evidence suggests that this latent scope bias may result from the same explanatory strategies used by adults (Experiments 1 and 2), and can be attenuated by strong prior odds (Experiment 4). We argue that children, like adults, rely on 'explanatory virtues' in inference - a strategy that often leads to normative responses, but can also lead to systematic error.

Sense-making under ignorance.

Much of cognition allows us to make sense of things by explaining observable evidence in terms of unobservable explanations, such as category memberships and hidden causes. Yet we must often make such explanatory inferences with incomplete evidence, where we are ignorant about some relevant facts or diagnostic features. In seven experiments, we studied how people make explanatory inferences under these uncertain conditions, testing the possibility that people attempt to infer the presence or absence of diagnostic evidence on the basis of other cues such as evidence base rates (even when these cues are normatively irrelevant) and then proceed to make explanatory inferences on the basis of the inferred evidence. Participants followed this strategy in both diagnostic causal reasoning (Experiments 1-4, 7) and in categorization (Experiments 5-6), leading to illusory inferences. Two processing predictions of this account were also confirmed, concerning participants' evidence-seeking behavior (Experiment 4) and their beliefs about the likely presence or absence of the evidence (Experiment 5). These findings reveal deep commonalities between superficially distinct forms of diagnostic reasoning-causal reasoning and classification-and point toward common inferential machinery across explanatory tasks.

Do the right thing: the assumption of optimality in lay decision theory and causal judgment.

Human decision-making is often characterized as irrational and suboptimal. Here we ask whether people nonetheless assume optimal choices from other decision-makers: Are people intuitive classical economists? In seven experiments, we show that an agent's perceived optimality in choice affects attributions of responsibility and causation for the outcomes of their actions. We use this paradigm to examine several issues in lay decision theory, including how responsibility judgments depend on the efficacy of the agent's actual and counterfactual choices (Experiments 1-3), individual differences in responsibility assignment strategies (Experiment 4), and how people conceptualize decisions involving trade-offs among multiple goals (Experiments 5-6). We also find similar results using everyday decision problems (Experiment 7). Taken together, these experiments show that attributions of responsibility depend not only on what decision-makers do, but also on the quality of the options they choose not to take.

Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable.

Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system.

When do consumers favor overly precise information about investment returns?

Consumers are often shown investment returns with high levels of precision, which could lead them to misunderstand the inherent uncertainty. We test whether consumers are drawn to precision-that is offset the uncertainty in investment decisions by over-relying on precise numerical information. Five incentivized experiments compared decisions when expected growth is presented in precise forecasts as opposed to ranges. Consumers are more likely to prefer and invest more in precise forecasts when they are evaluated jointly with ranges and when the range features a potential loss. Under these circumstances, precise forecasts give consumers more confidence to invest. This effect holds when consumers are told investment returns are uncertain. On the other hand, experiencing discrepancies between expected and actual growth dissipates the preference for precise forecasts. We identify conditions under which consumers are more likely to favor precise forecasts and how this could be avoided if necessary. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Rituximab reference vs biosimilar utilization for oncology vs nononcology indications.

OBJECTIVES: Limited data exist on the adoption of rituximab biosimilars vs the reference product by indication. Available data from real-world studies comparing rituximab biosimilar and reference use have focused predominantly on oncology indications. This is the first study to assess the utilization of the 3 US rituximab biosimilars vs the reference product. STUDY DESIGN: Comparative analysis. METHODS: Deidentified real-world data of rituximab, rituximab-abbs, rituximab-pvvr, and rituximab-arrx dispensations between December 31, 2018, and February 1, 2022, were extracted using Trisus Medication Compare (The Craneware Group). The primary outcome was rituximab reference vs biosimilar utilization for oncology vs nononcology indications. Results were stratified by on-label and off-label use and treatment settings. RESULTS: A total of 28,025 encounters were captured for rituximab and its biosimilars across 193 facilities (rituximab: n = 23,395; biosimilars, n = 4631 [rituximab-abbs: n = 2550; rituximab-pvvr, n = 2081; rituximab-arrx: n = 0]). Rituximab reference had higher dispensations for oncology (78.4%) and nononcology (88.3%) indications than its biosimilars (21.6% and 11.7%, respectively; P < .01). The 3-year annual trends from 2019 to 2021 revealed decreased rituximab reference utilization (99.99% to 40.1%) and increased biosimilar use (0.01% to 59.9%). Most oncology dispensations were on label (94.5%), whereas most nononcology dispensations were off label (73.6%; P < .01). A higher proportion of biosimilar use was attributed to on-label indications (67.7%; off-label, 32.2%) compared with rituximab reference (58.0% vs42.0%, respectively; P < .01). Nonacademic settings showed higher biosimilar adoption than academic settings (22.2% vs 10.3%, respectively; P < .01). CONCLUSIONS: Real-world evidence shows an increase in rituximab biosimilar adoption over time, with higher adoption for oncology vs nononcology indications and in nonacademic settings.

Win-win denial: The psychological underpinnings of zero-sum thinking.

A core proposition in economics is that voluntary exchanges benefit both parties. We show that people often deny the mutually beneficial nature of exchange, instead espousing the belief that one or both parties fail to benefit from the exchange. Across four studies (and 8 further studies in the online supplementary materials), participants read about simple exchanges of goods and services, judging whether each party to the transaction was better off or worse off afterward. These studies revealed that win-win denial is pervasive, with buyers consistently seen as less likely to benefit from transactions than sellers. Several potential psychological mechanisms underlying win-win denial are considered, with the most important influences being mercantilist theories of value (confusing wealth for money) and theory of mind limits (failing to observe that people do not arbitrarily enter exchanges). We argue that these results have widespread implications for politics and society. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Negative consequences of failing to communicate uncertainties during a pandemic: an online randomised controlled trial on COVID-19 vaccines.

OBJECTIVE: To examine the impact of the government communicating uncertainties relating to COVID-19 vaccine effectiveness on vaccination intention and trust after people are exposed to conflicting information. DESIGN: Experimental design where participants were randomly allocated to one of two groups. SETTING: Online. PARTICIPANTS: 328 adults from a UK research panel. INTERVENTION: Participants received either certain or uncertain communications from a government representative about COVID-19 vaccine effectiveness, before receiving conflicting information about effectiveness. MAIN OUTCOME MEASURES: Vaccination intention and trust in government. RESULTS: Compared with those who received the uncertain announcement from the government, participants who received the certain announcement reported a greater loss of vaccination intention (d=0.34, 95% CI (0.12 to 0.56), p=0.002) and trust (d=0.34, 95% CI (0.12 to 0.56), p=0.002) after receiving conflicting information. CONCLUSIONS: Communicating with certainty about COVID-19 vaccines reduces vaccination intention and trust if conflicting information arises, whereas communicating uncertainties can protect people from the negative impact of exposure to conflicting information. There are likely to be other factors affecting vaccine intentions, which we do not account for in this study. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/c73px/.

Principles of moral accounting: How our intuitive moral sense balances rights and wrongs.

We are all saints and sinners: Some of our actions benefit others, while other actions lead to harm. How do people balance moral rights against moral wrongs when evaluating others' actions? Across 9 studies, we contrast the predictions of three conceptions of intuitive morality-outcome-based (utilitarian), act-based (deontologist), and person-based (virtue ethics) approaches. These experiments establish four principles: Partial offsetting (good acts can partly offset bad acts), diminishing sensitivity (the extent of the good act has minimal impact on its offsetting power), temporal asymmetry (good acts are more praiseworthy when they come after harms), and act congruency (good acts are more praiseworthy to the extent they offset a similar harm). These principles are difficult to square with utilitarian or deontological approaches, but sit well within person-based approaches to moral psychology. Inferences about personal character mediated many of these effects (Studies 1-4), explained differences across items and across individuals (Studies 5-6), and could be manipulated to produce downstream consequences on blame (Studies 7-9); however, there was some evidence for more modest roles of utilitarian and deontological processing too. These findings contribute to conversations about moral psychology and person perception, and may have policy and marketing implications.

Factors influencing performance on the Board Certified Psychiatric Pharmacist Examination: Passing rates and domain-level scores.

The Board Certified Psychiatric Pharmacist (BCPP) specialty certification was launched by the Board of Pharmacy Specialties in 1994. Candidates for the BCPP can qualify for the examination through 3 possible pathways: practice experience (4 years) in the specialty, completion of a PGY-1 residency plus an additional 2 years of practice experience, or completion of a PGY-2 specialty residency in psychiatric pharmacy. Recent fluctuations in the passing rate raised questions as to explanatory factors. This article represents the first published comprehensive study of candidate performance on the BCPP Examination. It describes a retrospective, observational study presenting (a) statistical trends of examination passing rates for biannual cohorts over the past 5 years, as well as (b) score distributions on the 3 performance domains of the certification. Pass-rate trend analyses suggest that variation in the proportion of eligibility pathway cohorts in the respective testing samples explains some of the fluctuation in passing rates. An analysis of variance of domain-level scores, using groups defined by eligibility pathway, yielded significant differences for nearly all group comparisons. Evaluation of the effect sizes suggest that the most disparate performance was observed on the core clinical domain, Patient-Centered Care. The results of this study are consistent with previously published research and will inform the upcoming role delineation study for the Psychiatric Pharmacy Certification.

Incidence of hemorrhage among anticoagulated patients receiving antiplatelet therapy after percutaneous coronary intervention.

This study aimed to compare major hemorrhage rates among patients receiving warfarin, acetylsalicylic acid (ASA), and clopidogrel to those receiving ASA and clopidogrel following percutaneous coronary intervention with stent implantation. This retrospective cohort study identified patients with stents implanted between September 1, 2003 and December 31, 2006. Patients treated with warfarin, ASA, and clopidogrel within 30 days of hospital discharge (Triple Therapy group) were matched by age, sex, and stent type to patients treated with ASA and clopidogrel (Dual Therapy group). Outcomes included the incidence rates of major hemorrhage and major adverse coronary events (MACE) within 12 months of stent implantation. There were 175 and 339 patients in the Triple Therapy and Dual Therapy groups, respectively. There were 25 (14.3%) and 10 (3.0%) major hemorrhages in the Triple Therapy and Dual Therapy groups, respectively (OR 9.0; 95% CI, 3.1-26.1). Patients in the Triple Therapy group had a greater likelihood of MACE compared to patients in the Dual Therapy group (OR 2.0; 95% CI 1.1-3.8). Post-stent treatment with warfarin, ASA, and clopidogrel was associated with a substantially greater likelihood of major hemorrhage than treatment with ASA and clopidogrel alone.

Belief digitization: Do we treat uncertainty as probabilities or as bits?

Humans are often characterized as Bayesian reasoners. Here, we question the core Bayesian assumption that probabilities reflect degrees of belief. Across eight studies, we find that people instead reason in a digital manner, assuming that uncertain information is either true or false when using that information to make further inferences. Participants learned about 2 hypotheses, both consistent with some information but one more plausible than the other. Although people explicitly acknowledged that the less-plausible hypothesis had positive probability, they ignored this hypothesis when using the hypotheses to make predictions. This was true across several ways of manipulating plausibility (simplicity, evidence fit, explicit probabilities) and a diverse array of task variations. Taken together, the evidence suggests that digitization occurs in prediction because it circumvents processing bottlenecks surrounding people's ability to simulate outcomes in hypothetical worlds. These findings have implications for philosophy of science and for the organization of the mind. (PsycInfo Database Record (c) 2020 APA, all rights reserved).