Making Sense: Treating Patients with Opioid Use Disorder through the Lens of Game Theory.

The opioid epidemic continues to influence the field of medicine, creating new challenges and obstacles to quality care. Patients with injection drug use are marginalized individuals who received poor quality of care and often discharged without safe recovery plan. Cooperation between physicians and patients allow the best outcomes for the patient, the physician, and society, however we often see patient-directed discharges and inadequate care. We believe that this result is due to an incentive model in the decision-making process that ultimately makes cooperation difficult. We use different game theory models (assurance model, prisoner's dilemma, centipede model, conflicting interest coordination) in this paper to describe common scenarios within a hospitalization when caring for patient with opioid use disorder, from admission through discharge. When physician and patient are driven away from cooperation, the outcome is the worst and most harmful for society. In today's worsening opioid crisis, game theory can help physician provide high quality care to a complex high-risk population.

Does Spending More Always Ensure Higher Cooperation? An Analysis of Institutional Incentives on Heterogeneous Networks.

Humans have developed considerable machinery used at scale to create policies and to distribute incentives, yet we are forever seeking ways in which to improve upon these, our institutions. Especially when funding is limited, it is imperative to optimise spending without sacrificing positive outcomes, a challenge which has often been approached within several areas of social, life and engineering sciences. These studies often neglect the availability of information, cost restraints or the underlying complex network structures, which define real-world populations. Here, we have extended these models, including the aforementioned concerns, but also tested the robustness of their findings to stochastic social learning paradigms. Akin to real-world decisions on how best to distribute endowments, we study several incentive schemes, which consider information about the overall population, local neighbourhoods or the level of influence which a cooperative node has in the network, selectively rewarding cooperative behaviour if certain criteria are met. Following a transition towards a more realistic network setting and stochastic behavioural update rule, we found that carelessly promoting cooperators can often lead to their downfall in socially diverse settings. These emergent cyclic patterns not only damage cooperation, but also decimate the budgets of external investors. Our findings highlight the complexity of designing effective and cogent investment policies in socially diverse populations.

Strategic Self-Regulation in Groups: Collective Implementation Intentions Help Cooperate When Cooperation Is Called for.

Groups need contributions that are personally costly to their members. Such cooperation is only adaptive when others cooperate as well, as unconditional cooperation may incur high costs to the individual. We argue that individuals can use We-if-then plans (collective implementation intentions, cIIs) to regulate their group-directed behavior strategically, helping them to cooperate selectively with group members in the situation planned for. In line with this prediction, a cII to consider group earnings increased cooperative decisions in a prisoners' dilemma game when playing against another group member but not when playing against a stranger (i.e., non-group member). Moreover, cIIs to cooperate in the prisoners' dilemma game did not increase cooperation in a structurally similar investment game that participants had not planned for. We discuss the role of collective planning in solving social dilemmas.

A Brief Survey of the Prisoners' Dilemma Game and Its Potential Use in Biology.

Prisoners' Dilemma is a well-known game in game theory with many variations and applications in a number of fields. The addition of quantum strategies in this game opens up new possibilities and changes the equilibria of the game significantly.

Social cognition, behaviour and therapy adherence in frontal lobe epilepsy: a study combining neuroeconomic and neuropsychological methods.

Social behaviour of healthy humans and its neural correlates have been extensively studied in social neuroscience and neuroeconomics. Whereas it is well established that several types of epilepsies, such as frontal lobe epilepsy, lead to social cognitive impairments, experimental evidence on how these translate into behavioural symptoms is scarce. Furthermore, it is unclear whether social cognitive or behavioural disturbances have an impact on therapy adherence, which is critical for effective disease management, but generally low in these patients. In order to investigate the relationship between social cognition, social behaviour, and therapy adherence in patients with frontal lobe epilepsies (FLE), we designed a study combining conventional neuropsychological with behavioural economic and functional magnetic resonance imaging (fMRI) methodology. Fifteen patients and 15 healthy controls played a prisoners' dilemma game (an established game to operationalize social behaviour) while undergoing fMRI. Additionally, social cognitive, basic neuropsychological variables, and therapy adherence were assessed. Our results implicate that social behaviour is indeed affected and can be quantified using neuroeconomic methods in patients with FLE. Impaired social behaviour in these patients might be a consequence of altered brain activation in the medial prefrontal cortex and play a role in low therapy adherence. Finally, this study serves as an example of how to integrate neuroeconomic methods in neurology.

Cooperation can emerge in prisoner's dilemma from a multi-species predator prey replicator dynamic.

In this paper we study a generalized variation of the replicator dynamic that involves several species and sub-species that may interact. We show how this dynamic comes about from a specific finite-population model, but also show that one must take into consideration the dynamic nature of the population sizes (and hence proportions) in order to make the model complete. We provide expressions for these population dynamics to produce a kind of multi-replicator dynamic. We then use this replicator dynamic to show that cooperation can emerge as a stable behavior when two species each play prisoner's dilemma as their intra-species game and a form of zero-sum predator prey game as their inter-species game. General necessary and sufficient conditions for cooperation to emerge as stable are provided for a number of game classes. We also showed an example using Hawk-Dove where both species can converge to stable (asymmetric) mixed strategies.

Metacontingência, dilema do prisioneiro e cooperação: efeitos da interação verbal e da forma de apresentação da consequência cultural / Metacontingency, prisoners dilemma, and cooperation: effects of verbal interaction and form of cultural consequence presentation

Em uma metacontingência, respostas de dois ou mais indivíduos interagindo (denominadas um culturante) produzem estímulos (denominados de consequências culturais) capazes de afetar a recorrências daquelas respostas. Resultados de experimentos sobre metacontingência têm sido tratados como demonstrações de um tipo de seleção cultural. Além de sugerir a importância de interações verbais entre participantes, alguns desses experimentos têm empregado tarefas baseadas no dilema do prisioneiro repetido (iterated prisoners dilemma, IPD) interpretando-o, porém, como a programação apenas de contingências operantes. O Experimento 1 avaliou se um IPD com mais de 200 tentativas produziria escolhas cooperativas simultâneas de modo fidedigno e se a interação verbal entre participantes aumentaria a cooperação. 4 quartetos de universitários utilizaram 4 computadores conectados em rede (sem contato visual) e foram expostos a condições com ou sem permissão para usar uma sala de bate-papo pelo computador (chat) em um delineamento de linhas de base múltiplas entre quartetos. Os resultados demonstraram claramente que escolhas cooperativas unânimes podem ocorrer fidedignamente em um IPD e que a interação verbal entre participantes aumenta rapidamente tais escolhas. Esses resultados destacam a semelhança entre estudos sobre IPD e sobre metacontingências, nos quais são programadas consequências para comportamentos inter-relacionados de vários indivíduos. No Experimento 2, uma consequência cultural foi sobreposta às consequências já programadas pelo IPD: os quartetos podiam produzir pontos iguais para todos os participantes (feedback do mercado) contingentes a diferentes números de escolhas cooperativas. Como no Experimento 1, condições nas quais o uso do chat eram ou não permitidos foram arranjadas em um delineamento de linhas de base múltiplas entre quartetos. A interação verbal promoveu rápida e marcadamente a seleção cultural pelo feedback do mercado. Um quarteto... (AU)

In a metacontingency, responses of two or more interacting individuals (a culturant) produce stimuli (called cultural consequences) that affect the recurrence of those responses. Results of metacontingency experiments are said to demonstrate a kind of cultural selection. Besides suggesting the importance of verbal interactions between participants, some of these experiments have used tasks based on the iterated prisoner's dilemma (IPD) interpreting it, however, as programming only operant contingencies. Experiment 1 examined whether an IPD with 200-plus trials would produce simultaneous cooperative choices reliably and whether verbal interaction between participants would increase cooperation. 4 quartets of undergraduate and graduate students used 4 networked computers (without visual contact), and were exposed to conditions with or without permission to use the computer chat room in a multiple baseline design between quartets. Results clearly demonstrate that unanimous cooperative choices can occur reliably in an IPD, and that verbal interaction between participants rapidly increases such choices. These results highlight the similarity between IPD and metacontingencies studies, both of which program consequences for inter-related behaviors of many individuals. In Experiment 2, a cultural consequence was superimposed on the consequences already programmed by the IPD: quartets could produce equal points for all participants (market feedback) contingent on different numbers of cooperative choices. As in Experiment 1, we arranged conditions in which chat use were or not allowed in a multiple baseline design between quartets. Verbal interaction quickly and markedly promoted cultural selection by the market feedback. One quartet presented some control of culturants by the market feedback before verbal interactions, but production of cultural consequences increased substantially after using the chat. Experiment 3 replicated Experiment 2 presenting the... (AU)

Applying principles from the game theory to acute stroke care: Learning from the prisoner's dilemma, stag-hunt, and other strategies.

BACKGROUND: Acute stroke care represents a challenge for decision makers. Decisions based on erroneous assessments may generate false expectations of patients and their family members, and potentially inappropriate medical advice. Game theory is the analysis of interactions between individuals to study how conflict and cooperation affect our decisions. AIMS: We reviewed principles of game theory that could be applied to medical decisions under uncertainty. SUMMARY: Medical decisions in acute stroke care are usually made under constrains: short period of time, with imperfect clinical information, limit understanding about patients and families' values and beliefs. Game theory brings some strategies to help us manage complex medical situations under uncertainty. For example, it offers a different perspective by encouraging the consideration of different alternatives through the understanding of patients' preferences and the careful evaluation of cognitive distortions when applying 'real-world' data. The stag-hunt game teaches us the importance of trust to strength cooperation for a successful patient-physician interaction that is beyond a good or poor clinical outcome. CONCLUSIONS: The application of game theory to stroke care may improve our understanding of complex medical situations and help clinicians make practical decisions under uncertainty.