Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS

Gustavo Saposnik, Jorge Maurino, Angel P Sempere, Christian C Ruff, Philippe N Tobler, Gustavo Saposnik, Jorge Maurino, Angel P Sempere, Christian C Ruff, Philippe N Tobler

Abstract

Purpose: Herding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS) when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors) of herding in the management of MS.

Methods: We conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI) lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding.

Results: Out of 161 neurologists who were invited to participate, 96 completed the study (response rate: 60%). Herding was present in 75 (78.1%), having a similar prevalence in MS experts and general neurologists (68.8% vs 82.8%; P=0.12). In multivariate analyses, the number of MS patients seen per week was positively associated with herding (odds ratio [OR] 1.08, 95% CI 1.01-1.14). Conversely, physician's age, gender, years of practice, setting of practice, or risk preferences were not associated with herding.

Conclusion: Herding was a common phenomenon affecting nearly 8 out of 10 neurologists caring for MS patients. Herding may affect medical decisions and lead to poorer outcomes in the management of MS.

Keywords: decision-making; disease-modifying therapy; herding; multiple sclerosis; neuroeconomics; risk aversion.

Conflict of interest statement

Disclosure The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by an operating grant from Roche Farma Spain. The sponsors were not involved in the design, execution, analysis, and interpretation or reporting of the results. Dr Gustavo Saposnik is supported by the Distinguished Clinicians Scientist Award from HSFC. Dr Jorge Maurino is an employee of Roche Farma Spain. Prof Philippe Tobler and Christian Ruff were funded by the Swiss National Science Foundation (PNT: PP00P1_150739, CRSII3_141965, and 00014_165884, CCR:105314_152891, CRSII3_141965, and 320030_143443). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Prevalence of herding-like behavior according to specialty and volume of MS patients. Notes: (A) Herding-like behavior in MS specialists and general neurologists. (B) Prevalence of herding-like behavior by volume of MS patients seen per week (in terciles). Abbreviation: MS, multiple sclerosis.

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