Events

Pragmatic randomized controlled trials—known in the social sciences as field experiments, and in the tech industry as A/B tests—are important tools in a Learning Health System (LHS), or for evidence-based practice in any domain. They can rigorously compare the effectiveness of existing practices (e.g., approved drugs, procedures, healthcare delivery programs) and/or practice innovations, helping to identify wasteful, ineffectual, or even harmful practices, efficiently allocate limited resources, and inform iterative improvements in safety and quality. The alternative to an A/B test is often maintaining or implementing one or more untested standards of care without knowing their effects on patients and other stakeholders. Yet several A/B tests in healthcare and other domains have drawn strong public disapproval.  

Vignette experiments (N=10,737) exploring scenarios in medicine, public health, and non-health domains (e.g., autonomous vehicle safety, poverty alleviation, retirement savings) have found that both laypeople and clinicians can be averse to A/B tests, preferring that a decision-maker unilaterally implement option A or B for everyone instead of conducting an A/B test and making the superior intervention the standard of care going forward (Meyer et al., PNAS 2019; Heck et al., PNAS 2020; Vogt et al., BMJ Open 2024).  

However, in these previous studies, descriptions of the proposed A/B tests were silent about the presence or absence of consent, front door notice, and ethics oversight—three ethics policies that might reduce or eliminate experiment aversion. This talk will review this previous work, and then present some results from new vignette experiments (N=7,197) which investigate the effect of these policies on experiment aversion. It will also draw on qualitative work to discuss some reasons for experiment aversion and the implications of this work for learning health systems and other aspiring evidence-based organizations. 

Michelle N. Meyer, PhD, JD, HEC-C is associate professor and founding chair of the Department of Bioethics and Decision Sciences in the Geisinger College of Health Sciences, which unites researchers and practitioners interested in analyzing what decisions ought to be made, and how, with researchers who study what decisions people in fact tend to make, and how, and ways to improve decision-making. She is also Geisinger’s Chief Bioethics Officer, where her oversight responsibilities include clinical ethics, research ethics, precision health, data ethics, and AI ethics. 

In addition to conducting normative ethics scholarship and legal research, Michelle uses survey experiments and qualitative methods to investigate judgments and decision-making related to science, innovation, and health. As founding Faculty Co-Director of Geisinger’s Behavioral Insights Team (BIT), she also helps design, implement, and use large field experiments to rigorously evaluate provider- and patient-facing “nudges” and other lightweight interventions that aim to close care gaps, reduce overtreatment, encourage altruistic behavior, and otherwise make healthy choices easier.  

 Michelle’s work has appeared in leading journals of bioethics, law, science, and medicine, and in the New York Times, Slate, Wired, and the Los Angeles Times. Her research has been has been funded by the NIH (NIA, NHGRI, NCI, NCATS, Office of the Director), FDA, NSF, National Bureau of Economic Research (NBER) Roybal Center for Behavior Change in Health, Abdul Latif Jameel Poverty Action Lab (J-PAL), Russell Sage Foundation, and Robert Wood Johnson Foundation, and covered by Science, The Economist, and many other leading media outlets around the world. She is an elected Fellow of the Hastings Center. 

After graduating from Dartmouth College, she earned a Ph.D. in religious studies (theology, ethics, and culture) from the University of Virginia and a J.D. from Harvard Law School, where she was an editor of the Harvard Law Review. Following law school, she was a clerk on the U.S. Court of Appeals for the Eleventh Circuit and received postdoctoral training as a Greenwall Fellow in Bioethics and Health Policy at the Johns Hopkins and Georgetown Universities and a Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics Academic Fellow at Harvard Law School.