On a scale of 1 to 10, how hungry are you?, is a very different question from: On a scale of 1 to 10, how full are you? And not because an 8 on the fullness scale equates to a 2 on the hunger scale. The type of answer you get from a question has a lot to do with how you have asked the question—we call this concept in psychology “framing.” In speaking recently at the pharma industry’s flagship events on quality risk management (QRM) and risk-based monitoring (RBM), the question came up from the participants who have to effect this governance within their organizations: Should we be concerned with the concept of risk, or is what we are really trying to get at the concept of relevance?”

This is an important question, and perhaps more important to the overall outcome to the industry than you may know. We had conducted an observational study of patient-physician interactions, and in those cases there were 2 conditions:

• Condition 1: The physician tells the patient that the treatment intervention has a 90% success rate.
• Condition 2: The physician tells the patient that there’s a 10% failure rate in the treatment intervention.

And guess what? Overwhelmingly, those patients for whom the treatment was proposed as having a 90% success rate elected to pursue it. This was not the case for the other group. In fact, many more opted to not be treated with what they figured was a more inferior and potentially dangerous medical treatment. But certainly something that succeeds in benefiting 9 out of 10 people will fail for the 1 out of 10 users who attempt it on average. So what’s the difference? The difference is in how we perceive the framed language. When framed in the positive (success), the patient feels more optimistic. However, when framed in the negative (failure), the patient may think that their current condition is just fine, and why run the risk of making it worse.

What are we actually intending to measure and improve? Quality risk, or quality relevance?
This is at the neuroscientific intersection of the inquiry of risk vs. relevance. We tend to perceive the language of risks as things that can make our current condition worse, whether it’s financially, medically or otherwise. Whereas relevance can tend to put us into a positive frame of mind—after all, those things which are relevant for our business or personal lives must be good, right? So thinking about an ordinally-sorted list of relevancies may get us thinking differently about that list than one which is a matrix of risks. Avoid the risks, but do more of the relevancies. And while we have not yet done this experiment, it makes sense in the context of these psychological biases that if we created two lists, one which was risks to the business, and the other list of relevant items to address for business success—if we sorted the two lists and started choosing which ones to reduce from the risks or capitalize on from the relevancies, we would likely have not only two different lists, but we’d probably rank them differently and go down further to a different threshold of score ranking in one list relative to the other. And this difference would be due to the language-induced framing that we’ve undertaken to build the lists, our risk tolerance and our individual positivity biases. 

References and Further Reading
Locwin, B. (2013). Quality risk assessment and management strategies for biopharmaceutical companies. BioProcess International. http://www.bioprocessintl.com/upstream-processing/assays/quality-risk-assessment-and-management-strategies-for-biopharmaceutical-companies-348568/
Ariely, D. (2009). Predictably irrational. New York, NY: Harper-Collins Publishers.

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Ben Locwin

Ben Locwin, PhD, MBA, MS writes the Clinically Speaking column for Contract Pharma and is an author of a wide variety of scientific articles for books and magazines, as well as an acclaimed speaker. He is an expert media contact for the American Association of Pharmaceutical Scientists (AAPS) and a committee member for the American Statistical Association (ASA). He also provides advisement to many organizations and boards for a range of business, healthcare, clinical, and patient concerns. He can be reached at ben.locwin@healthcarescienceadvisors.com.