Ebola and Cognitive Bias

By Michele Goodwin

In the wake of another health care worker contracting Ebola, alarm bells are ringing. Last week, President Obama abruptly cancelled a campaign stop to Rhode Island to hold press conferences where he promised that federal authorities are “taking this very seriously at the highest levels of government.” Despite Obama’s assurances that the dangers associated with the disease spreading in the US are extremely low, other political camps are less convinced. Mitt Romney, the former Governor of Massachusetts, urged officials to close US borders to countries experiencing Ebola outbreaks, basically quarantining West Africa from travel to the United States.

In light of the hysteria surrounding Ebola and not Enterovirus, it’s worth thinking about our national response. Enterovirus has already claimed more lives in the US than Ebola. Think about this, the CDC warns that enteroviruses are highly contagious and already more than 500 patients have been diagnosed across 43 states in the past couple months. Yet, there has been no national outcry or demands to quarantine states, cities, local communities, or hospitals where patients were treated. Why?

Unlike the enterovirus, the face of Ebola is decidedly immigrant or “outsider.” It’s origins are Africa.  Could these factors have contributed to Thomas Eric Duncan’s initial treatment at a Texas hospital and the inaccurate media accounts shortly following his diagnosis? Studies show how cognitive or implicit biases may have much to do with how we treat patients. 

Implicit biases are rapid, automatic, heuristic-driven actions. In other words, they are shortcuts the brain makes. Such biases are largely unconscious in nature, but shaped by socio-cultural learning that apply positive and negative valence to demographic categories, most notably race and ethnicity.

In the healthcare context, implicit racial bias can influence individual decisions about a particular patient.  Compelling research indicates that racial disparities persist in diagnostic screening, general medical care, mental health diagnosis and treatment, pain management, HIV-related care, and treatments for cancer, heart disease, diabetes, and kidney disease.

For example, compared to white patients, Blacks are less likely to receive cardiac catheterization for acute myocardial infarction. They are also significantly less likely to undergo coronary artery bypass grafting even after controlling for appropriateness and medical necessity, to receive organ transplants, and even receive appropriate pain management.

The point is that our national response to Ebola can be influenced by subconscious biases.  Quite possibly implicit biases have already influenced our national response to Ebola.  Thomas Eric Duncan was not the first to enter the US with Ebola—he simply happened be the first and only person to die from the disease in the US–and our first immigrant case.

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2 thoughts on “Ebola and Cognitive Bias

  1. What health decision is NOT influenced by cognitive bias? We place too much faith in human judgments and not enough in tools to protect us from our failings. The problem with the first Ebola case wasn’t just our biases, but our failure to communicate and act on relevant information’s that actually was available (I.e.., that the patient had recently returned from west Africa).

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