Search

BackgroundRandomized controlled trials (RCTs) are essential for determining the safety and efficacy of healthcare interventions. However, both laypeople and clinicians often demonstrate experiment aversion: preferring to implement either of two interventions for everyone rather than comparing them to determine which is best. We studied whether clinician and layperson views of pragmatic RCTs for Covid-19 or other interventions became more positive early in the pandemic, which increased both the urgency and public discussion of RCTs.MethodsWe conducted several survey studies with laypeople (totaln=2,909) and two with clinicians (n=895;n=1,254) in 2020 and 2021. Participants read vignettes in which a hypothetical decision-maker who sought to improve health could choose to implement intervention A for all, implement intervention B for all, or experimentally compare A and B and implement the superior intervention. Participants rated and ranked the appropriateness of each decision.ResultsCompared to our pre-pandemic results, we found no decrease in laypeople’s aversion to non-Covid-19 experiments involving catheterization checklists and hypertension drugs. Nor were either laypeople or clinicians less averse to Covid-19 RCTs (concerning corticosteroid drugs, vaccines, intubation checklists, proning, school reopening, and mask protocols), on average. Across all vignettes and samples, levels of experiment aversion ranged from 28% to 57%, while levels of experiment appreciation (in which the RCT is rated higher than the participant’s highest-rated intervention) ranged from only 6% to 35%.ConclusionsAdvancing evidence-based medicine through pragmatic RCTs will require anticipating and addressing experiment aversion among both patients and healthcare professionals.

Non-ability-based confidence is confidence in one’s ability that is not calibrated to actual ability. Here, we examine what psychological factors are associated with possessing more or less confidence relative to one’s ability and to what extent genetic and environmental processes contribute to these links. Using data from the Texas Twin Project ( N = 1,588 participants, aged 7–15 years), we apply a latent variable residual approach to calculate non-ability-based confidence as self-rated confidence net of ability on standardized cognitive tests. Non-ability-based confidence was modestly heritable (9%–28%) and strongly positively correlated with the need for cognition, mastery goal orientation, grit, openness, and emotional stability. These correlations were partly mediated by genetic factors (57% of the association on average). This widespread pattern of associations between non-ability-based confidence and several other measures of thinking, feeling, and acting suggest that non-ability-based confidence can be conceptualized as a personality attribute.

Non-ability-based confidence is one of the most pervasive human psychological biases. It is a part of a family of confidence judgments, including overconfidence and metacognitive calibration accuracy, defined by a discrepancy between self-perception of ability and actual ability. Across many domains, most people exhibit some degree of miscalibration in their confidence. Some people may be overconfident and others are underconfident. Despite the prevalence of non-ability-based confidence, relatively little research has investigated how non-ability-based confidence develops and why some people are more or less confident than others despite sharing the same level of ability. We use a longitudinal dataset to explore the childhood predictors of adolescent non-ability-based confidence. Achievement growth in math and reading in childhood was modeled and used to predict adolescent non-ability-based confidence in math and reading. Results show that the initial level of achievement predicts lower non-ability-based confidence in math. On the other hand, a faster rate of achievement growth across childhood predicts greater non-ability-based confidence in reading. These results highlight how previous experiences inform people’s self-perceptions over and above their true abilities. Discussion focuses on the factors that shape non-ability-based confidence over the lifespan and the limitations of the current findings.

Humans frequently benefit others strategically to elicit future cooperation. While such forms of calculated reciprocity are powerful in eliciting cooperative behaviors even among self-interested agents, they depend on advanced cognitive and behavioral capacities such as prospection (representing and planning for future events) and extended delay of gratification. In fact, it has been proposed that these constraints help explain why calculated reciprocity exists in humans and is rare or even absent in other animals. The current study investigated the cognitive foundation of calculated reciprocity by examining its ontogenetic emergence in relation to key aspects of children’s cognitive development. Three-to-five-year-old children from the US (N = 72, mostly White, from mixed socioeconomic backgrounds) first completed a cognitive test battery assessing the cognitive capacities hypothesized to be foundational for calculated reciprocity. In a second session, children participated in a calculated reciprocity task in which they could decide how many resources to share with a partner who later had the opportunity to reciprocate (reciprocity condition) and with a partner who could not reciprocate (control condition). Results indicated a steep developmental emergence of calculated reciprocity between 3 and 5 years of age. Further analyses showed that measures of delay of gratification and prospection were important predictors of children’s rate of calculated reciprocity, even when controlling for age and after including a measure of verbal ability. By contrast, theory of mind abilities were unrelated to children’s reciprocal behavior. This is the first systematic investigation of essential cognitive capacities for calculated reciprocity. We discuss prospection and delay of gratification as two domain-general capacities that are utilized for calculated reciprocity and which could explain developmental as well as species-differences in cooperation.