Teaching consumer behavior at one of the world's leading business schools and studying medical decision making don't seem to go hand in hand. While the latter is intended to increase health and wellbeing the former is, at times, shady, or at least carries the potential for ethical transgressions. As Kyle, one of my students, recently put it "but by teaching us all the biases and means of persuasion, aren't you teaching us how to lie?"
My usual retort is that we are both marketers and consumers. As marketers we are under some constraints, and flat out lying is forbidden, although manipulation is common practice. As consumers, we need to know the shticks that marketers, or anyone for that matter, might pull at us.
Dr. Robert Goldberg's book, Tabloid Medicine, helps unveil multiple shticks, often pulled by seemingly uninterested parties, targeted at our consumption of medication. This is even worse than Kyle had in mind, for, rather than hurting our pockets, these practices can hurt our health, and the health of those we hold nearest and dearest.
Goldberg, co-founder and vice president of the Center for Medicine in the Public Interest. (CMPI), spares no effort in describing the decision science principles which allow people to be easily persuaded by pseudo-truths and scandalized reports. And these are, in fact, the principles I teach Kyle and other students. To name a few: people are more easily persuaded by stories than by numbers, so a "it happened to my neighbor (or better still, my child)" account will forever be more convincing than "100,000 other children underwent the same treatment and remained unscathed". This ties in with the availability heuristic, suggesting that phenomena for which no example quickly comes to our mind, are considered less likely than if an example quickly pops up. Thus, while vaccinations against, say, the measles, do an excellent job at eradicating the disease, they do themselves a disservice, by making examples of measles and its perils scarce, therefore causing parents to believe the vaccination unnecessary.
To make things worse, the internet has brought about a proliferation of information sources. Coupled with the human tendency to make quick and dirty judgments, often based on cues (such as a caption proclaiming someone as ‘an expert' but not indicating whether they have medical or other training, rather than on a thorough examination of facts, this may prove dangerous. Goldberg cites a report from Kelton Research, posted in July 2008, that 85.6 million Americans (38% of US adults) had "doubted the opinion of their doctors or other medical professionals when it conflict[ed] with information found online." In an era that idolizes the democratization of knowledge, Goldberg powerfully claims that patients who operate AMA are "making themselves not empowered but vulnerable to anyone who tells them what they want to hear."
Goldberg goes so far to dub this ‘web of fear', also point out that general search engines are more likely to bring up popular, less credited sources. Thus, for side effects of Crestor, only 34% of search results were from reliable sources, and a staggering 47% came from class action and litigation sources. Which brings us to the next question, of ‘who might benefit from this'? In the case of the autism scare, Goldberg points a finger at ‘instant experts' who gain celebrity status promoting scarcely-tested views, and scientific claims from easily refuted studies. And because of our psychological wiring, these sensationalized accounts are often better attended to than level headed, balanced accounts. So an IOM committee, as well as peer reviewed articles in top medical journals such as Pediatrics, found virtually no connection between the MMR vaccination and autism. So what? In an era on tabloid medicine, scares and personal stories have better PR than do solid evidence. And, in spite of scientific evidence that no autism-vaccination exists, instant experts claim otherwise and grab media attention. Unfortunately, this comes at the cost of immunization rates plummeting, sometimes to a mere 50% in the UK, and resulting cases of measles, some of which have resulted in death.
Tabloid Medicine also dispels myths is that of mental health, where antidepressants have been accused of leading to suicide, and too many patients who could have benefitted from them were scared away. This is a painful topic, given the prevalence of depression, and its devastating consequences.
Not often does a book do such a thorough job at illuminating biased media coverage, vulpine self-appointed experts, and, even scarier, our own biased interpretation of evidence and pseudo evidence, and how it can harm our health. It's an uphill battle and one worth fighting, because, rather than teaching my students how to lie, I would rather teach them to detect when they are being lied to. This one's for you, Kyle, and for anyone out there who values his or her health.