Story by Margie Peterson
Image by iStock/Nanzeeba Ibnat
Joseph Vitriol uses gout to prove the point.
A few years ago, Joseph Vitriol, an applied psychologist and assistant professor of management at Lehigh Business, was approached by a pharmaceutical company about how rheumatologists often appear reluctant to prescribe a safe and effective biological treatment for gout.
The pharmaceutical company’s drug proved successful in treating inflammatory arthritis, of which gout is an acute form. For centuries, gout has been called “the disease of kings” because it was believed to be caused by overconsumption of alcohol and rich foods.
“Gout is a common and severe form of inflammatory arthritis but it’s often described or perceived as a disease of excess,” says Vitriol. “Those who suffer from gout are often described as lazy, decadent, gluttonous architects of their own suffering and misfortune. This is inaccurate.
“The best available scientific evidence tells us that it’s not only about lifestyle choices,” he says. “It’s not [just] the behaviors that those who suffer from gout engage in that is causing their pain and suffering. Despite the fact that gout is largely determined by biological and hereditary factors, the stigma persists.”
“While gout patients suffer terribly, they are often afraid to talk about their condition or seek treatment because of that stigma,” Vitriol says.
To find out what was deterring rheumatologists from prescribing the pharmaceutical company’s effective medicine, Vitriol teamed up with a team of rheumatologists to design and conduct a study that included about 400 rheumatologists who had completed their residency and had at least a year or two working in the field. The researchers developed realistic vignettes about hypothetical patients with the conditions found in one of three diseases: gout, rheumatoid arthritis or uncontrolled gout.
“Rheumatoid arthritis and gout have a lot of similarities,” Vitriol says. “It’s just that gout is more severe, more chronic and more harmful.”
For the study, published in the journal Social Science & Medicine, the rheumatologists reviewed the patients’ profiles that included three parts: a description of the patient’s symptoms and discomfort; their diagnostic lab test results; and descriptions of the patient’s level of activity, diet, body mass index and usage of drugs, alcohol and tobacco.
“What we found is that the disease state itself didn’t matter,” Vitriol says. "The rheumatologists in this sample were ignoring lab results and patient symptomology. They were highly influenced by or unduly influenced by these non-diagnostic factors, such as lifestyle and behavioral choices."
“What you see is that patients with high levels of stigma, based on their behavioral profile, were more likely to be diagnosed as having gout, independent of lab results,” he says. “High stigma patients were perceived as less likely to benefit from pharmacological treatment, less likely to comply, less likely to adhere with the doctor’s recommendation.”
Vitriol hopes the study will be a wake-up call for the medical community.
“Bias often operates when people don’t know it exists,” Vitriol says. “Our hope is that rheumatologists, while they may not be happy to learn they’ve been reaching judgments based on inaccurate information, should nonetheless be open to learning and changing their practice based on new information.”
Vitriol has focused much of his research on bias and says everyone has biases and they often operate outside of conscious awareness.
“It can operate automatically without people even being aware that it’s influencing their thinking or their judgment,” he says. The key is to be willing to examine stereotypes and assumptions and call them out.
Why it Matters
"What’s the problem with bias?” asks Vitriol. “It’s a systematic source of error. It’s a source of inaccuracy in our thinking, reasoning and our individual and collective decision-making capacities."