Do you own a fully self-driving car? Unless you’re Elon Musk, you probably don’t. Mostly because they’re really hard to develop (we’ve been trying since 1977).1 Computers are really good at calculating 231 to the power of 2,483, but not so good at handling complex situations in real life.
By contrast, the human mind crunches through complex multi-faceted tasks like driving with glorious indifference (well…mostly…anyone remember Maureen from 90s hit docuseries Driving School?). You make those decisions about obstacles and routes in a split-second – sometimes without knowing you made them.
How do you do it? Well it’s not by logically crunching the data like a computer would. In reality, we rely on in-built biases, heuristics (guesses based on probability) and mental shortcuts to get through our days.
Like it or not, you’re biased.
Deviations from logic that influence a person’s judgements are known as “cognitive biases”, which the human brain uses as a stepping stone to quick decision-making.2,3 Anchoring is one such bias, and it’s typically described as an over-reliance on the first piece of information provided about a topic.4
Imagine you’re buying a car. The salesperson initially asks for £12,000. You take the brochure away to think it over, but then get a call half an hour later. Great news! They can cut you a special deal. The car you love, but with a £2,000 discount. This, you think, is a bargain and you happily part with your cash and drive away the car of your dreams.
When you look online later, however, you discover the RRP is £9,995.
In that moment you realise two things. Firstly, the value of always doing your homework (another good writing trait in our line of work). And secondly, that the car salesperson knows a thing or two about anchors (and probably doesn’t have many repeat customers).
Anchoring to a piece of information (in this case, £12,000) can profoundly influence your judgement about information you receive afterwards. It’s one of the most common biases in psychology,4 affecting various aspects of life, including legal judgements and how much we’re willing to pay for things.5
Several factors can influence anchoring bias. For example, people who feel sad, are very trusting, or have low extraversion tend to show more susceptibility to anchoring bias. On the other hand, knowledgeable people or people with higher cognitive ability are less influenced by anchors.5
Why is anchoring relevant to healthcare communications?
Even though anchoring bias tends to influence knowledgeable people less, experts can still be affected. And healthcare professionals are no different.
When it comes to communication between doctors and patients, studies have shown that some doctors anchor their level of communication against their own benchmark of medical knowledge, overestimating what the patient will understand.6,7
More starkly, a 2020 study reported that anchoring was the most frequently identified bias among 32 American doctors when choosing whether to administer HPV vaccines to adolescents. Although they should have offered vaccines to all children aged 11–12 years – if they’d been following national guidelines – over 30% of the clinicians stated that their first impression of the patient’s maturity (and how likely they felt it was that their patient was sexually active) influenced their decision on whether to vaccinate or not.8
But what does this have to do with market access?
Quite a lot actually, because cognitive biases (including anchoring) pervade all human decision making. For example, when people mentally benchmark the price of a product (medicine), they’re influenced by previous experience of the same product, or current prices of similar products (a concept known as “coherent arbitrariness”).9 The same goes for efficacy, safety and all manner of other aspects of the value of a new therapy.
And the impact that this has is often unclear. People’s pre-conceived anchors may be obvious. Pricing of comparator therapies is an example where it’s fairly easy to predict what the mental anchor will be. But when it comes to efficacy or safety, it may not be so easy to predict.
Put simply, the way people think often isn’t strictly rational. And as a consequence it can be challenging to frame language in a way that accounts for people’s pre-conceived anchors.
There is hope though. Forewarned is forearmed. And knowing about these cognitive biases means that we can think about how we can mitigate against their impact.
So what can I do?
Here’s a few things to think about the next time you put pen to paper:
- Know your audience: We all know that payers will anchor to other therapies, or to the same therapy in another disease area. But is that all? Are you confident that you know your audience well enough to predict their anchors? Have you asked? Because it might make the difference between an impactful or an ineffective value proposition.
- Be clear: Make sure you’re crystal clear in all your communications about what you think the anchors, or points of comparison, for your therapy are. Don’t be vague. And don’t leave this to the interpretation of your reader
- Know your limits: Payers, thankfully, tend to be knowledgeable, well-educated people, and this may help them overcome anchoring bias. But not every time. Everyone’s biased. You, me, budget holders, clinicians. It’s just the way we think. So be mindful when you’re writing that you’re probably limited in what you can do to mitigate against this bias
- If all else fails: We said above that sadness makes anchoring bias stronger. Hey, if you’ve run out of other ideas, perhaps you could cheer them up with chocolate?
- caranddriver.com. Future Past: Self-Driving Cars Have Actually Been Around for a While. Available at: https://www.caranddriver.com/news/a15343941/future-past-self-driving-cars-have-actually-been-around-for-a-while/ [last accessed: 02/08/2022]. 2016.
- Tversky A, Kahneman D. Judgment under Uncertainty: Heuristics and Biases. Science. 1974;185(4157):1124-1131.
- Lieder F, Griffiths TL, QJ MH, Goodman ND. The anchoring bias reflects rational use of cognitive resources. Psychon Bull Rev. 2018;25(1):322-349.
- Lab TD. Why we tend to rely heavily upon the first piece of information we receive | Anchoring Bias, explained. Available at: https://thedecisionlab.com/biases/anchoring-bias/. Accessed September, 2021.
- Furnham A, Boo HC. A literature review of the anchoring effect. The Journal of Socio-Economics. 2011;40:35-42.
- Chapple A, Campion P, May C. Clinical terminology: anxiety and confusion amongst families undergoing genetic counseling. Patient Educ Couns. 1997;32(1-2):81-91.
- Senay I, Kaphingst KA. Anchoring-and-adjustment bias in communication of disease risk. Med Decis Making. 2009;29(2):193-201.
- Hansen CE, North A, Niccolai LM. Cognitive Bias in Clinicians’ Communication about Human Papillomavirus Vaccination. Health Commun. 2020;35(4):430-437.
- Ariely D, Loewenstein G, Prelec D. “Coherent arbitrariness”: stable demand curves without stable preferences. The Quarterly Journal of Economics. 2003;118(1):73-105.