Personal view: the paradox of runaway competitions in gastroenterology

Occasionally, gastroenterologists harbour reservations about the appropriateness of various procedures and management options, yet find themselves drawn into a competition and forced by outside exigencies to provide such services. The aim of the present analysis was to describe patterns of runaway competitions and factors that influence their occurrence in gastroenterology. The interactions between two physicians or physician and patient are modelled as non-zero-sum games of two players. The outcomes associated with two behavioural strategies of two players are arranged in a two-by-two game matrix. Many scenarios of clinical gastroenterology and social interactions among gastroenterologists are characterized by the underlying game of prisoner's dilemma, where two players can choose to co-operate or compete with each other. Although from their joint perspective co-operation results in a higher joint utility, the perspective of each individual favours competition. Following the inescapable logic of their individual perspective, the players end up with a worse outcome than through co-operation. A runaway competition ensues if the game is played repeatedly with players successively increasing their stakes. Ultimately, each player tries to outdo the opponent while heading in the wrong direction. Recognizing the hallmarks of the game of prisoner's dilemma may help gastroenterologists to avoid such competitions.