Table 1

‘Cognitive Biases Plus’ and healthcare evidence

Conflicts of interest (CoIs)
 Financial, non-financial and intellectual CoIs (often co-occur)Circumstances in which a self-serving factor (gain) has the potential to prejudice views and decisions. Non-financial CoIs include desire for promotion, prestige, etc. Intellectual CoI is driven by a strong personal belief and likely confounds all discourses. Potential for succumbing to CoI is intrinsic to all humans. CoIs are necessary catalysts for the cascade (see figure 1)
Individual or group cognitive biases
 Self-serving bias (incentive bias)The most important of all biases. Judgment influenced by personal or organisational (self-serving) motives
 Confirmation bias (interpretive bias)Favouring evidence supporting one's preconception and ignoring evidence that does not support it. Often associated with anchoring and consistency
 In-group conformity (social proof)Increasing confidence in a decision when it is in agreement with others
 Authority bias and halo effectUncritical acceptance, even without coercion, of the views of authority, including expert groups and high-impact publications
 ReductionismReducing complex or uncertain scenarios into simpler ideas or concepts. The resulting evidence risks being flawed for the often complex clinical situations seen in clinical practice
 AutomationUncritical use of automated technology, including statistical software, apps with preappraised sources of evidence, decision support systems and the like. An increasingly important bias
Group or organisational cognitive biases
 Scientific inbreedingThe practice of those trained in the same school of thought/or by the same experts, working together in the same field. High risk for groupthink and replication publication biases. Similar to academic or intellectual inbreeding
 Groupthink (inside view)The views of close-knit/inbred decision-making groups risk becoming homogeneous; opposing views are discouraged or disregarded
 Herd effect (lemming effect, emperor's new clothes effect)Alignment of thoughts or behaviours in a group/organisation, often catalysed by authority. Decisions or opinions of authority are accepted/obeyed unquestioningly. Social media are becoming important catalysts (‘the viral effect’)
Fallacies (logical errors in reasoning)
 Two examples (individual, group or organisational level)Planning fallacy: Incorrectly estimating the benefits of policies or actions, and/or unrealistically discounting costs and consequences
Sunk cost fallacy: Reluctance or inability to change course when too much has been invested
Ethical violations
 A spectrumRange of behaviours including subtle statistical manipulations, selective publication and outright fabrication. Associated with rationalisation and self-deception. In healthcare, no ethical violation is minor: all can harm
  • Elements of ‘cognitive biases plus’. Only some of the many (frequently co-occurring) cognitive biases and fallacies are listed. The table and figure supplement each other. The contents are substantially condensed and revised from (1) table 1 in Seshia et al.4 and (2) table 1 in Seshia et al.5 Publisher: John Wiley & Sons Ltd. Please refer to the references for details and primary references.