Outside the field of medicine, for example in law and economics, information asymmetry deals with the study of decisions where one party has more or better information than the other. This asymmetry creates an imbalance of power in decision making and transactions, which can sometimes cause these decisions or transactions to go awry and cause a breakdown in trust or market failure as worst-case scenarios. Examples of this problem are (01) adverse selection, (2) moral hazard, and (3) monopolies of knowledge.
Information asymmetry extends to the field of medicine. For example, if a Pharma company has better information than regulators about serious adverse events of their newly licensed drug they may take covert actions to bypass new regulation. There are many examples of this and this undermines the effectiveness of regulation and the trust we have in the Pharmaceutical industry.
Another example of information asymmetry is what happens in the typical doctor-patient relationship. Doctors may have more information than their patients, which results in an imbalance of power in decision making. Unless the doctor takes steps to correct this information asymmetry as part of the consultation process this can have serious consequences if decisions go wrong or are even perceived to go wrong; the result is usually a breakdown in trust between the doctor and patient and can have other more unpleasant ramifications.
As a practising neurologist, I always try and correct any information asymmetry between myself and my patients, but this is not always possible given the time constraints placed on us within the NHS. Many other factors, in particular, cultural and language barriers, prevent you from correcting information asymmetry. It also plays both ways; in the modern era, patients often know more about their disease and are more up to date with the latest developments in their disease area, than their doctors. In this situation are the doctors prepared to take time to listen and learn?
One of the reasons for starting this blog was to correct information asymmetry and to create a platform for the dissemination of knowledge and how this knowledge impacts on clinical practice. I, therefore, read with interest a letter in this weeks BMJ from a retired GP and patient, which succinctly addresses the problem of information asymmetry. Do you agree with him? I am particularly impressed with his concluding sentence: “The big danger of a monopoly on knowledge is just that: the absence of mechanisms to challenge it.”
If you have any personal examples of how information asymmetry has affected the management of your MS please feel free to share them with us.
Can we create a platform/mechanism to allow people like Roger Weeks and yourselves to challenge this ‘monopoly of knowledge’?
Roger Weeks. A monopoly on knowledge is bad for patients. BMJ 2019;365:l2254
Patients and their doctors should be grateful to deBronkart for highlighting the lack of access to new information about illnesses. Clearly, the advice of Abigail Adams to her president and husband, John Adams, has been ignored not just in the US but worldwide. The unlimited power of academics with a monopoly on knowledge is unchanged. The delivery of such knowledge to patients (and their doctors) at their moment of need may well not be solved by the highly unlikely achievement of open access publishing (as raised in some of the rapid responses to the commentary). Information needs about diseases and their treatment are not well served by the current patient information leaflets universally found in medication packs because they relate only to the product and to conditions treatable by the product.
As a doctor, I see that comprehensive electronic information on conditions is needed. It should include all treatments and pathways, with drug and non-drug treatments (such as physical treatments including manipulation, operations, and mind and even alternative treatments), and be accessible to all on demand. These information resources need to be as global as possible to inform patients about new developments in treating their disorder and about selected drugs. The information should be based on reliable sources, including the National Institute for Health and Care Excellence, the NHS, summaries of product characteristics, patient leaflets, Food and Drug Administration labels, and selected research papers. I contribute to work on this.
As a patient with all the latest available information on my late onset eosinophilic asthma treatment, I find great difficulty in persuading specialists to provide me with a new biological agent (with a stated 60% benefit rate), even though I can demonstrate that all their reservations are based on pre-conceived ideas, not fact. The big danger of a monopoly on knowledge is just that: the absence of mechanisms to challenge it.