Disclosure: Transparency May Be Hazardous to Your Health

By Edward Tenner

A new study says that doctors and other people who disclose conflicts of interest are more likely to indulge in bad behavior

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The Boston Globe's Ideas section reports that disclosing conflicts might encourage professionals to be less ethical and clients less critical:

[T]he twist came when the researchers required the experts to disclose this conflict to the people they were advising. Instead of the transparency encouraging more responsible behavior in the experts, it actually caused them to inflate their numbers even more. In other words, disclosing the conflict of interest—far from being a solution—actually made advisers act in a more self-serving way.

"We call it moral licensing," [the behavioral economist Don] Moore says. "After having behaved honestly and virtuously, you then feel licensed to indulge in being a little bit bad." Other recent findings on ethical behavior, he says, show that people compensate for virtuous acts with vice, and vice versa. "People behave as if they have a moral 'set point,'?" Moore says. Indeed, it appeared that disclosing a conflict of interest gave people a green light to behave unethically, as if they were absolved from having to consider others' interests.

Forewarned is apparently disarmed, the story continues:

Sunita Sah, a researcher at Duke University's Fuqua School of Business, has conducted experiments focusing on doctor-patient interactions, in which a doctor prescribes a medication but discloses a financial interest in the company that makes the drug. As expected, most people said such a disclosure would decrease their trust in the advice. But in practice, oddly enough, people were actually more likely to comply with the advice when the doctor's bias was disclosed. Sah says that people feel an increased pressure to take the advice to avoid insinuating that they distrust their doctor.

Similar demonic situations are everywhere when you start looking for them. At least early in the introduction of anti-lock brakes, cars equipped with them were involved in more accidents than others. Filter-cigarette smokers tend to inhale more deeply. A McDonald's salad with dressing and croutons may have more fat and calories than a Big Mac. And moral licensing at the very least makes it hard to stay green.

The paradoxes of disclosure are more serious. They indict not just our appetites for fast cars and rich food but our ethics and judgment. Those dire side-effect warnings during consumer pharmaceutical commercials may be not so much turn-offs as subtle inducements.

What's the answer? I'm not sure it's a good idea to add, after revelation of possible conflicts, a further caution: "This disclosure may cause us to act even more self-interestedly and may lower your critical judgment." Who knows, maybe if people were reminded of this effect it might become even worse.

Of course, there are also unintended consequences of using unintended consequences to stop or reverse reform. Transparency can be invaluable. But there's growing evidence it's insufficient.


Image: sandman_kk/flickr

This article available online at:

http://www.theatlantic.com/health/archive/2011/05/disclosure-transparency-may-be-hazardous-to-your-health/239276/