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.

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.

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).

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.

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/.

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).

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.

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.

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.

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).

Role of board certification in advancing pharmacy practice

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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.

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.

Intuitions about mathematical beauty: A case study in the aesthetic experience of ideas.

Can an idea be beautiful? Mathematicians often describe arguments as "beautiful" or "dull," and famous scientists have claimed that mathematical beauty is a guide toward the truth. Do laypeople, like mathematicians and scientists, experience mathematics aesthetically? Three studies suggest that they do. When people rated the similarity of simple mathematical arguments to landscape paintings (Study 1) or pieces of classical piano music (Study 2), their similarity rankings were internally consistent across participants. Moreover, when participants rated beauty and various other potentially aesthetic dimensions for artworks and mathematical arguments, they relied mainly on the same three dimensions for judging beauty-elegance, profundity, and clarity (Study 3). These aesthetic judgments, made separately for artworks and arguments, could be used to predict similarity judgments out-of-sample. These studies also suggest a role for expertise in sharpening aesthetic intuitions about mathematics. We argue that these results shed light on broader issues in how and why humans have aesthetic experiences of abstract ideas.

Non-interventional cardiologists' perspectives on the role of pharmacogenomic testing in cardiovascular medicine.

AIM: To evaluate factors influencing cardiologists' perspectives about pharmacogenomic (PGx) testing in clinical practice. PATIENTS & METHODS: Semistructured interviews with practicing cardiologists were qualitatively analyzed to identify common themes. RESULTS: Five themes were identified among 16 cardiologists from four specialties (n = 5 general cardiology, n = 3 electrophysiology, n = 2 adult congenital and n = 6 heart failure/transplant): cardiologists' knowledge and needs, perceived clinical validity and utility of PGx testing, dissemination and management of PGx results, patient-related considerations and incidental findings. CONCLUSION: Lack of evidence was considered by many cardiologists to be a major barrier hindering the use of PGx testing. However, they would consider adopting PGx if they were provided additional education, ongoing support and evidence supporting the clinical utility of PGx testing in cardiovascular medicine.

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.