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Omission Bias

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Cognitive Errors and Diagnostic Mistakes

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Abstract

Herbert was a 34-year-old man suffered from multiple sclerosis (MS) for 8 years. His initial symptom was trouble walking, and he was found to have multiple demyelinating lesions in his spine and brain. He was placed on glatiramer acetate, a safe, but only partially effective treatment. He continued to have multiple relapses with resultant progression in his disability. Five years into his disease course, he was using a cane and had developed cognitive and visual impairment. The decision was made to place him on natalizumab, a monoclonal antibody given intravenously every month. It is highly effective in preventing relapses in MS, however carries a significant risk for a potentially fatal viral infection known as progressive multiple focal leukoencephalopathy (PML). The causative virus is the JC virus, and Herbert had serum antibodies against the JC virus detected in his serum. In patients with significantly elevated antibody levels, the risk of PML is about one in 100. Based on Herbert’s blood tests, he had an approximately 1:1000 risk of contracting PML if continued on natalizumab.

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  1. Neurology and Psychiatry, NYU Langone Medical Center, New York, NY, USA

    Jonathan Howard MD

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Howard, J. (2019). Omission Bias. In: Cognitive Errors and Diagnostic Mistakes. Springer, Cham. https://doi.org/10.1007/978-3-319-93224-8_19

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