title: Do decision biases predict bad decisions? Omission bias, naturalness bias, and influenza vaccination.
abstract: OBJECTIVE
  Numerous studies using hypothetical vignettes have demonstrated decision biases or deviations from utility theory. Do people who commit biases in questionnaire studies make worse real-world decisions than do less biased people?
  
  
  METHODS
  Two hundred seventy university faculty and staff participated in a questionnaire study in which they reported whether they accepted a free influenza vaccine offered at their work place. Influenza vaccine acceptance was the measure of real-world decision making. Participants responded to 3 hypothetical scenarios. Two scenarios measured the omission bias and described a vaccine (scenario 1) and a medication (scenario 2) that prevented a negative health outcome but that itself could cause the negative health outcome. The omission bias is a preference for not vaccinating or medicating even when the vaccine/medication lowers the total risk of the negative outcome. A 3rd scenario measured the naturalness bias by presenting a choice between 2 chemically identical medications, one extracted from a natural herb and the other synthesized in a laboratory. Preference for the natural medication indicated the naturalness bias.
  
  
  RESULTS
  The results indicated that a substantial proportion of participants exhibited these biases and that participants who exhibited these biases were less likely to accept the flu vaccine.
  
  
  CONCLUSIONS
  To the extent that declining a free flu vaccine is a worse real-world decision, people who demonstrate the naturalness and omission biases in hypothetical scenarios make worse real-world decisions.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. dibonavm@mskcc.org
authors.forename: Marco daCosta
authors.initials: Md
authors.lastname: Dibonaventura
authors.forename: Gretchen B
authors.initials: GB
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D015982:Bias; D003657:Decision Making; D005260:Female; D015438:Health Behavior; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology*