The role of nudges in studies comparing drugs with empiric dosing

In this issue of Gastrointestinal Endoscopy, Han et al1 compare the safety and efficacy of remimazolam with propofol in sedating patients undergoing ERCP. As an anesthesiologist with interest in procedural sedation, I can comment both as a principal investigator and from practical clinical experience. I believe the study, perhaps more than most, illustrates an issue in study design that has not been adequately addressed in the literature—the effect of nudges on dose selection in empiric dosing. A nudge is a measure that influences behavior without direct financial incentives.