Respiratory Therapy 101: Just Keep Breathing

I’ve often wondered how it is that so much bad information gets disseminated among medical people. A favorite example of mine is the misunderstanding among many medical professionals that albuterol will relieve the symptoms of Congestive Heart Failure. Albuterol doesn’t do anything for CHF: in fact it could conceivably make it worse. Yet it seems that four of five nurses with a patient in CHF demand albuterol treatments, when what the patient in fact needs is diuresis via lasix. How does this bad idea spread from one person to another despite constant correction?

We like to think that people improve their judgment by putting their minds together, and sometimes they do. The studio audience at “Who Wants to Be a Millionaire” usually votes for the right answer. But suppose, instead of the audience members voting silently in unison, they voted out loud one after another. And suppose the first person gets it wrong.

If the second person isn’t sure of the answer, he’s liable to go along with the first person’s guess. By then, even if the third person suspects another answer is right, she’s more liable to go along just because she assumes the first two together know more than she does. Thus begins an “informational cascade” as one person after another assumes that the rest can’t all be wrong.

Because of this effect, groups are surprisingly prone to reach mistaken conclusions even when most of the people started out knowing better, according to the economists Sushil Bikhchandani, David Hirshleifer and Ivo Welch. If, say, 60 percent of a group’s members have been given information pointing them to the right answer (while the rest have information pointing to the wrong answer), there is still about a one-in-three chance that the group will cascade to a mistaken consensus.

Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children). Unable to keep up with the volume of research, doctors look for guidance from an expert — or at least someone who sounds confident. –>article here<–

Ah…suddenly, it makes sense.