The ‘availability’ bias: underappreciated but with major potential implications

Many biases have been described that potentially introduce prejudice or a systemic error into a study that would favor one outcome versus another. One major source of bias has, so far, been underappreciated: the availability bias. When the study intervention is available to clinicians outside of the clinical trial, the trial could become biased to favor the control study arm. Clinicians may, consciously or unconsciously, use this intervention outside of the trial on patients whom they believe would benefit from the intervention, and enroll in the trial those patients for whom they do not feel strongly about the benefit of the intervention. The clinicians do not always share the equipoise of the study investigators. This could have major implications on the analysis of clinical trials, including the systematic reviews that originate from such trials.