The COI Cascade

A PubMed search using “conflict of interest” as a search term returned one article from 1974. Three appeared in 1975. The number reached 98 in 1991. In 1995, 252 appeared. In 1997, the number reached 236. In 2009, Lanier (editor, Mayo Clinic

Proceedings) returned more than 7300 articles, 70% published over the previous decade. British Medical Journal, Journal of the American Medical Association, The New England Journal of Medicine, and The Lancet registered more than 195, 170, 160, and 125 COI items each. The evidence is that COI was made increasingly “available” in the professional and public media (PubMed Spread Sheet 1974-2013).

PubMed Spread Sheet

An availability cascade has been described as a self-reinforcing process of collective belief formation, by which an expressed perception triggers a chain reaction that gives the perception ever increasing plausibility through its apparent availability in public discourse. The driving mechanism involves a combination of informational and reputational motives: individuals endorse the perception partly by learning from the apparent beliefs of others and partly by conforming, even distorting their public responses in the interest of maintaining social acceptance (Kuran and Sunstein 1999).

Availability entrepreneurs are activists who manipulate the content of public discourse, who strive to trigger and sustain availability cascades likely to advance their agendas. Availability campaigns sometimes yield social benefits, but they also bring harm, by hijacking social resources for precaution-taking that would better promote the general welfare when used elsewhere. Most cascades tend to die out. But their institutionalized effects linger and are very difficult to undo and often become permanent.