All the UK newspapers this weekend ran a story – based on an industry press release – about how select staff in UK NHS received £40M in 2012 from UK Pharmaceutical companies for consultancy and sponsorship. £40m is a lot of money, and it was interesting to see that, although the figures were released part of a ‘transparency drive’ by the industry most articles looked to rekindle debate over potential conflicts of interest.
This conundrum over conflict of interest seems to be based on the difference between explicit and implicit bias. An explicit bias is known by the person who has the bias. An implicit bias is one that is not recognized by anyone.
I have an explicit bias in favour of UK airlines for trans-Atlantic travel (majority of travellers are on same time zone as me), and I am happy that everyone knows. Implicit biases, however, are more difficult because – by definition – even the person who involved doesn’t realise it. One of the best examples I have seen of (apparent) implicit bias is that fact that whilst only 5% of US men are greater than six feet tall, 85% of US male CEOs are over six feet tall.
So back to our industry then and this week’s disclosure – presumably whatever anxiety there is about this sort of funding is based on generic concerns that it may lead to a conflict of interest and – unintentionally – to implicit bias in associated or resultant decisions affecting UK healthcare and patients.
The interesting twist though, is that implicit and explicit bias is a well understood concept, and that therefore we have access to a great deal of advice about how best to overcome or avoid implicit bias…in any situation…and whether that bias is real or not.
Ironically, the first step is always to be open and transparent – open to the idea that implicit bias may exist; transparent about any factors that may influence our decisions (conflicts of interest in other words). The second step is focussed on awareness and concern – awareness of the potential for implicit bias to impact a decision, and concern about the effects of any bias. And these steps work as well for industry funding decisions as they do for personal investment decisions or even for scientific analysis.
We have to accept that we all have potential for implicit bias. We all process data all the time, and inevitably we use and apply our experience to that processing…and this is a good thing since it would not be possible otherwise! We recognise ‘patterns’ – cause and effect…event and response…and over time we start to apply ‘shortcuts’ to make sense of situations we find ourselves in, challenges we face, or opportunities that appear in front of us.
But as well as being how we survive, making these ‘implicit associations’ will inevitably lead to learned responses to events and stereotypes between people…and our implicit biases are created.
Therefore, in addition to transparency and awareness, the third step to overcome implicit bias has to be a conscious decision to change our instinctive and implicit reactions to data, events and opportunity.
There are many straightforward strategies to change behaviours associated with implicit bias, but I like the simplest. Accountability – when we know we will be expected to explain our decisions, it is inevitable that we will exhibit less bias. Diversity of thought – involving and interacting with others (people unlike ourselves) generally, but especially when we make key decisions will always help avoid stereotypical thinking.
Avoiding implicit bias is not just a good thing to do…it can – and does – lead to better decisions. And it is more engaging and enjoyable.