When Drugs Kill: Cognitive Structures in the Production of Evidence

Prescription drugs reduce pain and save lives, but they also kill and injure hundreds of thousands of patients each year. The drugs responsible for killing and injuring most patients have typically been on the market for many years before being pulled off. This paper develops and tests a theory that can account for the lengthy market presence of unsafe drugs. The analyses are based on one of the primary data sources used to identify drugs as unsafe â€" the set of complaints about drugs filed by patients and physicians. The main argument developed in this paper holds that reporting behavior is guided by the cognitive structure in which the drug implied in the complaint is embedded. This structure stems from similarity in the health condition that a drug treats and is invoked when new information about the safety of drugs is released. The fact that physician behavior is guided by this structure, while patient behavior is not, and the fact that this structure is temporarily invoked are sources of ambiguity for the regulator responsible for monitoring drug safety. This presentation argues that an understanding of how and when patients and physicians attribute an effect to a cause may reduce the lengthy market presence of unsafe drugs.

Speaker: Mathijs de Vaan