Month: July 2022

Keeping the ship afloat: Boldly changing course to avoid ‘sunken’ costs

by Matt Wheeler |

Reasoned decision-making is a vital skill in all walks of life. In a vacuum, this means examining all the options and rationally picking the best course of action. But, in the real-world, there are factors that might cloud judgement or introduce bias, and it’s important to keep a look out for these. One such tendency is known as the ‘sunken cost fallacy’.

Oxford Languages define the sunken cost fallacy as “the phenomenon whereby a person is reluctant to abandon a strategy or course of action because they have invested heavily in it, even when it is clear that abandonment would be more beneficial.” This theory could relate to any number of steps within healthcare. Ideally, it should not inform decision making, but, in reality, the human nature is susceptible to it.

It’s often quoted that only 10% of drug development projects make it all the way from Phase I to approval. The other 90% of ‘failures’ may fall at many different hurdles, for instance due to a lack of efficacy, an unacceptable safety profile, or acknowledgement of likely lack of commercial interest. Significant resources, both financial and time expended, will have already been invested in development when these warning signs appear, but clearly the rational (and ethical) decision is not to pursue these drugs further, regardless of ‘sunken cost’.

When it comes to clinical decision making, there are ways in which, in theory, sunken cost fallacy could impact decision making. If a healthcare provider has started a patient on an expensive therapy, but it becomes apparent that it is not working, might they be susceptible to continuing the treatment, rather than switching to something less expensive? Or would a doctor be less willing to entertain an alternative diagnosis if they had already spent considerable time on the original investigations that have led to a potentially incorrect conclusion? A cross-sectional, in-person survey of 36 medical residents, conducted by Bornstein et al in 1999, found that their evaluation of treatment decisions “reflected good reasoning, in that they were not influenced by the amount of time and/or money that had already been invested in treating a patient.” Interestingly, these skills were not shown to extrapolate to the evaluation of non-medical situations by the same people.

What of pharmaceutical marketing? Perhaps a pharma giant has invested millions of pounds over a number of years in cultivating a presence at an international congress, every year constructing the same eye-catching booth and updating their panels with the latest data for their brand (and serving great coffee…). They’ve formed great relationships with the organisers, and are well into preparation for the 2023 event in Melbourne. Unfortunately, COVID-19 Upsilon (sorry) means that whilst the congress will go ahead, no HCPs will be able to travel into Australia from any of the key target markets for the brand. Should they continue to invest in the event, or cut their losses?

Perhaps this all sounds a bit far-fetched – we all like to think we are (at least largely) rational in our decision-making. But the lesson seems a good one: investment in a project or idea should not preclude abandonment, if it is the right thing to do, whether this applies to healthcare professionals, pharmaceutical companies, or in fact within healthcare communications; hard though those conversations with clients might be. Not much use in updating the reference access dates and re-approving that beautifully designed, cutting-edge website that nobody has visited since 2018, after all; far better to expand the range of targeted, data-driven emails that have demonstrably increased market share and sales… This is not to dissuade investment or creativity, by any stretch – just to point it in the right direction boldly, and to have the bravery to change course when necessary.

Juggling work and the menopause

by Becky Pamplin |

About 10 years ago, a friend of mine brought a handful of leaflets about the menopause to a social evening. I carried on drinking and chatting and didn’t pay any attention to the leaflet. I thought I was way too young and didn’t need to know about that yet. And then of course, I didn’t recognise the symptoms.

The crippling anxiety – I thought it was just how I was now. Forgetting words – signs of dementia? Disturbed sleep every night – is this what happens as you get older? Hot flushes, night sweats – I started to get the picture.

The effects of these symptoms were far-reaching and had a significant impact on my work-life. Events at work such as making an important presentation or attending a meeting somewhere new, which I would previously have taken in my stride, had me feeling physically sick with anxiety for days beforehand. I went from being someone with an excellent memory to someone who could forget an ordinary word in front of a room full of people. And the disturbed sleep made it difficult for me to concentrate at work and affected my ability to shrug off a difficult day. (I’m sure those of you who have young children can empathise with this too!)

After trying various solutions, I eventually went to the doctor for help. I found out that I was perimenopausal (‘perimenopause’ meaning the time in which the body is making the transition to the menopause), and a range of treatments were suggested: herbal remedies, medication for the anxiety and sleep-related symptoms, or HRT.

I never did get as far as trying HRT, because I ended up having treatment for breast cancer last year. The cancer was oestrogen-receptor positive, meaning that it uses oestrogen to grow. So HRT is ruled out and I now have to take an oestrogen-blocking medicine, which has side effects that are effectively menopausal symptoms. Just what I need!

I always try to look on the bright side – and there are many actually, so here are a few of them. I changed my job – and I’m so much happier now. I learned how to crochet; I love it, it helps with managing anxiety, and I even sell some of my creations. I faced the onslaught of breast cancer treatment-related side effects fairly pragmatically, as I’d already been dealing with most of them for several years. And now that I’ve started telling people at work that I’m menopausal, we can have a shared laugh about the unpleasant symptoms too.

My work is home-based, and I’ve discovered some coincidental advantages to this. If I suddenly feel boiling hot, I can change my outfit. If my face goes bright pink on a Zoom call, I can turn my camera off for a bit! Now that I’m not commuting, I can go for a walk before starting work, which helps me sleep better.

Why am I telling you all of this?

Menopausal women may need flexibility and understanding in order to keep working, but there is still quite a taboo around talking to people about it. Maybe we keep quiet about our experiences due to embarrassment or fear that we will be judged as less able to do our jobs.

There has definitely been some progress. There have been two documentaries on Channel 4 presented by Davina McCall about the menopause which, together with her social media campaigns, have really made a difference in raising awareness and enabling conversations about what women going through the menopause are experiencing.

The UK Government’s cross-party Menopause Taskforce met for the first time this year. The taskforce will tackle issues including increasing access to treatment and ending the taboos that still surround conversations about the menopause, including in the workplace. An increasing number of companies now have a menopause policy and specific menopause-awareness training.

There is noticeably more talk on LinkedIn about the menopause now. There are various websites set up to provide menopause advice. Products are now specifically marketed for menopausal women (from shampoo to tea), and the TENA #LastLonelyMenopause campaign on TV brings a tear to my eye every time I watch it. All of these things help to normalise the conversation and break down stigma, and it feels like we are moving in the right direction.

Menopause facts and figures

  • Women going through the perimenopause/menopause can experience a wide range of symptoms, which may have a significant impact on daily life.1
  • The most common symptoms include host flushes, night sweats, difficulty sleeping, low mood/anxiety, joint aches, and problems with memory and concentration.1,2 In fact, as many as 48 symptoms have been linked to the meopause.3
  • In a survey featured as part of Davina McCall’s latest documentary on Channel 4, 44% of women said their ability to work has been affected by menopausal symptoms.4
  • One in ten women who have been employed during the menopause have left work due to menopause symptoms.4


  1. NHS. Symptoms of the menopause. Available at: Accessed July 2022.
  2. Menopause Matters. Menopause symptoms. Available at: Accessed July 2022.
  3. GenM. The 48 symptoms of the menopause. Available at: Accessed July 2022.
  4. The Fawcett Society. Menopause and the Workplace, 2022. Available at: Accessed July 2022.