I really don’t like the term “mechanistic bias”, to me it implies that the human body is not mechanistic and that mechanistic explanations are wrong.
The failure here is not that people “buy” a mechanistic action (along the line of symptom X is because of Y, and treatment Z will change Y and lead to symptom X going away or be lessened).
That in itself is fine, the problem is that people do not understand that the human body is very complicated. Which means that for a lot of things we really don’t know the root cause, and the more “wrong” we are about the root cause, the more wrong a potential treatment will be.
Basically we do not have a good model of the human body, and pharmacodynamics, pharmacokinetics are often in the “we think/suspect/believe category”.
IMO “complexity bias” / “mechanistic complexity bias” captures the failure more precisely.
A personal anecdote:
I suffer from severe and debilitating migraines. And for years, well decades actually, my doctor(s) tried what feels like everything.
You go through lists of drugs, 1st choice, 2nd choice etc. and I ended up trying drugs on the list where the “evidence” for effectiveness often was apocryphal.
Conversations with a doctor about them usually sounded like this “We think you should try X, you see X affects Y (well really a-Z, but mainly Y—we think), and Y might be a cause” which to me sounds a lot like “plausible sounding mechanism of action”
What ended up working in the end was something on the last list, but I got it prescribed for a totally unrelated thing.
And in retrospect there was hints that a drug doing what this drug does might be worth trying.
I really don’t like the term “mechanistic bias”, to me it implies that the human body is not mechanistic and that mechanistic explanations are wrong.
The failure here is not that people “buy” a mechanistic action (along the line of symptom X is because of Y, and treatment Z will change Y and lead to symptom X going away or be lessened).
That in itself is fine, the problem is that people do not understand that the human body is very complicated. Which means that for a lot of things we really don’t know the root cause, and the more “wrong” we are about the root cause, the more wrong a potential treatment will be.
Basically we do not have a good model of the human body, and pharmacodynamics, pharmacokinetics are often in the “we think/suspect/believe category”.
IMO “complexity bias” / “mechanistic complexity bias” captures the failure more precisely.
A personal anecdote:
I suffer from severe and debilitating migraines. And for years, well decades actually, my doctor(s) tried what feels like everything.
You go through lists of drugs, 1st choice, 2nd choice etc. and I ended up trying drugs on the list where the “evidence” for effectiveness often was apocryphal.
Conversations with a doctor about them usually sounded like this “We think you should try X, you see X affects Y (well really a-Z, but mainly Y—we think), and Y might be a cause” which to me sounds a lot like “plausible sounding mechanism of action”
What ended up working in the end was something on the last list, but I got it prescribed for a totally unrelated thing.
And in retrospect there was hints that a drug doing what this drug does might be worth trying.