{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T22:20:57Z","timestamp":1767910857617,"version":"3.49.0"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi240936-4\"><jats:title>Importance<\/jats:title><jats:p>A goal of health care is to reduce symptoms and improve health status, whereas continuing dubious treatments can contribute to complacency, discourage the search for alternatives, and lead to shortfalls in care.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240936-5\"><jats:title>Objective<\/jats:title><jats:p>To test a potential bias in intuitive reasoning following a marginal improvement in symptoms after a dubious treatment (post hoc bias).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240936-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Surveys eliciting treatment recommendations for hypothetical patients were sent to community members throughout North America recruited via an online survey platform in the early winter months of 2023 and 2024 and presented to health care professionals (pharmacists who were approached in person using a secret shopper technique) in the summer months of 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240936-7\"><jats:title>Exposure<\/jats:title><jats:p>Respondents received randomized versions of surveys that differed according to whether vague symptoms improved or remained unchanged after a dubious treatment.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240936-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was a recommendation to continue treatment.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240936-9\"><jats:title>Results<\/jats:title><jats:p>In total, 1497 community members (mean [SD] age, 38.1 [12.5] years; 663 female [55.3%]) and 100 health care professionals were contacted. The first scenario described a patient with a sore throat who took unprescribed antibiotics; respondents were more likely to continue antibiotics after initial treatment if there was a marginal improvement in symptoms vs when symptoms remained unchanged (67 of 150 respondents [45%] vs 25 of respondents [17%]; odds ratio [OR], 3.98 [95% CI, 2.33-6.78]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Another scenario described a patient with wrist pain who wore a copper bracelet; respondents were more likely to continue wearing the copper bracelet after initial care was followed by a marginal improvement in symptoms vs when symptoms remained unchanged (78 of 100 respondents [78%] vs 25 of 99 respondents [25%]; OR, 16.19 [95% CI, 5.32-19.52]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). A third scenario described a patient with fatigue who took unprescribed vitamin B<jats:sub>12<\/jats:sub>; respondents were more likely to continue taking vitamin B<jats:sub>12<\/jats:sub> when initial treatment was followed by a marginal improvement in symptoms vs when symptoms remained unchanged (80 of 100 respondents [80%] vs 33 of 100 respondents [33%]; OR, 7.91 [95% CI, 4.18-14.97]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Four further scenarios involving dubious treatments found similar results, including when tested on health care professionals.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240936-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study of clinical scenarios, a marginal improvement in symptoms led patients to continue a dubious and sometimes costly treatment, suggesting that clinicians should caution patients against post hoc bias.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.31123","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T15:01:56Z","timestamp":1725462116000},"page":"e2431123","source":"Crossref","is-referenced-by-count":4,"title":["Post Hoc Bias in Treatment Decisions"],"prefix":"10.1001","volume":"7","author":[{"given":"Donald A.","family":"Redelmeier","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Center for Leading Injury Prevention Practice Education & Research, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eldar","family":"Shafir","sequence":"additional","affiliation":[{"name":"Department of Psychology, Princeton University, Princeton, New Jersey"},{"name":"Princeton School of Public and International Affairs, Princeton, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"issue":"1","key":"zoi240936r1","first-page":"13","article-title":"Fallacies and the evaluation of reasoning.","volume":"18","author":"Finocchiaro","year":"1981","journal-title":"Am Philos Q"},{"issue":"4","key":"zoi240936r3","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1007\/s11606-019-04839-5","article-title":"Practicing medicine with colleagues: pitfalls from social psychology science.","volume":"34","author":"Redelmeier","year":"2019","journal-title":"J Gen Intern Med"},{"issue":"8","key":"zoi240936r4","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1007\/s11606-011-1655-3","article-title":"Determining whether a patient is feeling better: pitfalls from the science of human perception.","volume":"26","author":"Redelmeier","year":"2011","journal-title":"J Gen Intern Med"},{"key":"zoi240936r5","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1146\/pharmtox.2018.58.issue-1","article-title":"Adverse effects of nutraceuticals and dietary supplements.","volume":"58","author":"Ronis","year":"2018","journal-title":"Annu Rev Pharmacol Toxicol"},{"key":"zoi240936r6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/17453674.2021.1979793","article-title":"Arthroscopic partial meniscectomy: did it ever work?","volume":"93","author":"Reito","year":"2021","journal-title":"Acta Orthop"},{"issue":"6","key":"zoi240936r7","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1177\/014107688708000601","article-title":"Is Occam\u2019s razor disposable?","volume":"80","author":"Tatham","year":"1987","journal-title":"J R Soc Med"},{"issue":"1","key":"zoi240936r9","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s12911-016-0377-1","article-title":"Cognitive biases associated with medical decisions: a systematic review.","volume":"16","author":"Saposnik","year":"2016","journal-title":"BMC Med Inform Decis Mak"},{"issue":"4","key":"zoi240936r10","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1001\/jama.1995.03520280048038","article-title":"Medical decision making in situations that offer multiple alternatives.","volume":"273","author":"Redelmeier","year":"1995","journal-title":"JAMA"},{"issue":"2","key":"zoi240936r11","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1177\/0272989X221121343","article-title":"The fallacy of a single diagnosis.","volume":"43","author":"Redelmeier","year":"2023","journal-title":"Med Decis Making"},{"issue":"1","key":"zoi240936r13","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1186\/s13690-022-00979-z","article-title":"Secret shopper studies: an unorthodox design that measures inequities in healthcare access.","volume":"80","author":"Rankin","year":"2022","journal-title":"Arch Public Health"},{"key":"zoi240936r14","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1016\/j.jebo.2020.07.007","article-title":"Natural disasters and risk aversion.","volume":"177","author":"Bourdeau-Brien","year":"2020","journal-title":"J Econ Behav Organ"},{"issue":"9","key":"zoi240936r15","doi-asserted-by":"publisher","first-page":"799","DOI":"10.7326\/0003-4819-120-9-199405010-00012","article-title":"\u201cClinical judgment\u201d revisited: the distraction of quantitative models.","volume":"120","author":"Feinstein","year":"1994","journal-title":"Ann Intern Med"},{"issue":"6957","key":"zoi240936r16","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1136\/bmj.309.6957.780","article-title":"Some examples of regression towards the mean.","volume":"309","author":"Bland","year":"1994","journal-title":"BMJ"},{"issue":"4","key":"zoi240936r17","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1037\/h0059151","article-title":"Reductionism.","volume":"52","author":"Sloane","year":"1945","journal-title":"Psychol Rev"},{"issue":"10","key":"zoi240936r18","doi-asserted-by":"publisher","first-page":"3050","DOI":"10.1007\/s11606-020-05864-5","article-title":"Pitfalls from psychology science that worsen with practice.","volume":"35","author":"Redelmeier","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"6","key":"zoi240936r20","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1056\/NEJMra1907805","article-title":"Placebo and nocebo effects.","volume":"382","author":"Colloca","year":"2020","journal-title":"N Engl J Med"},{"key":"zoi240936r21","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/B978-0-12-385522-0.00005-6","article-title":"The Dunning\u2013Kruger effect: on being ignorant of one\u2019s own ignorance.","volume":"44","author":"Dunning","year":"2011","journal-title":"Adv Exp Soc Psychol"},{"issue":"1","key":"zoi240936r22","first-page":"12","article-title":"The history of bloodletting.","volume":"52","author":"Greenstone","year":"2010","journal-title":"B C Med J"},{"issue":"2","key":"zoi240936r23","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1001\/jamaneurol.2023.5208","article-title":"SARS-CoV-2 vaccination and neuroimmunological disease: a review.","volume":"81","author":"Willison","year":"2024","journal-title":"JAMA Neurol"},{"key":"zoi240936r2","volume-title":"Designing Clinical Research","author":"Browner","year":"2023","edition":"5th ed"},{"key":"zoi240936r8","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/978-3-030-28513-5_7","volume-title":"Fallacies in Medicine and Health: Critical Thinking, Argumentation and Communication","author":"Cummings","year":"2020"},{"key":"zoi240936r19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1525\/9780520913523","volume-title":"I, Candidate for Governor: And How I Got Licked","author":"Sinclair","year":"1994"},{"key":"zoi240936r24","volume-title":"Thinking: Fast and Slow","author":"Kahneman","year":"2011"},{"key":"zoi240936r12","unstructured":"Prolific Survey. Accessed July 25, 2024. https:\/\/www.prolific.com"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2823147\/redelmeier_2024_oi_240936_1724777572.00548.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T15:02:03Z","timestamp":1725462123000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2823147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,4]]},"references-count":24,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.31123","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,4]]}}}