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Friday, January 20, 2012

The Art of Medical Deception (Part II)

The well in the clearing...
I started this with Part I a few days ago.

I'd like to think about the difference between advertising medicine and advertising food.

Its been known since the time of Pavlov (the late 1800's) that animals (including humans) process stimulus-based links - ring the bell every time you feed the dog and soon the dog salivates when the bell is rung.

I suspect that in the Kahneman "Thinking, Fast and Slow" world of "System 1" this is how System 1 is trained.  Anyone who owns a pet knows that the pet usually learns the habits of its owners.  My dog knows me so well he goes and lays in the shower right before I take one...

Like Pavlov's dogs we respond directly and predictably to stimulus.  Show a picture of a big, juicy hamburger or fresh, hot pizza on a TV and the phone lines start to ring with orders.  Show a fantastic looking body and people call the "weight loss" clinic.

"System 1" doesn't usually wait around to figure out if calling is a good idea, it simply creates a desire for whatever it thinks would be good for you.

After all, its always, at least historically, a good idea to eat when food is available.

Similarly in the animal world.  Before civilization and pets you ate when you could because you could not predict when you would be able to eat again.  I think in large part this is how our thinking about things like food (which is stimulated with sight as well as other things) evolved.  See the food, go after it.  Those that saw food and thought about, say, taking a nap, probably didn't do as well over all.

Now let's compare this to medical ads.

First of all food is something that is driven with immediate satisfaction - no one usually goes more than eight hours with eating.  The results of eating are a state of "fullness" that tells you you don't need to eat more.  If you see a vacation spot that attracts your attention - you think about it or order tickets.  If you see a weight loss ad you call up or go online and join up.

But in all cases there is a direct "result" - a membership, an airline ticket, a full stomach, nice memories.

Now when I think about medical ads (say something like Lipitor) I believe the model is different.  Since these things are generally sold to "reduce the risk of X" its not the same as, say eating.  Eating is generally good and it keeps you alive.  The medical version is vague and there is no obvious immediate direct benefit, i.e, a full stomach, and long term there may or may not be a measurable benefit associated.

So let me try and make an analogy (I am going to try and pretend to be like Kahneman):

Suppose you live in a primative village on a remote ridge.  You live there with one hundred or so other folks.

On a far away ridge there lives a sniper.  He has a high powered rifle with a silencer that shoots magic bullets that kill you but leave no obviously identifiable marks.

On average the sniper kills five people each year.  To do this he uses a high-powered scope and, sitting on his porch, he picks off one of your villagers.

In your village people are periodically found dead of no obvious cause.  Your job is to study this and figure out why.

So you make up a table listing all the dead people on the left and you make columns to the right listing facts about their deaths: time of day, where they were found, various facts you can associate with each death.

Since life is primitive death is no stranger but there does seem something odd about this.  One thing you notice is that, near the clearing where the well is, more people seem to die of the mysterious and unexplained cause than any other.

So in your primitive scientific mind you associate the deaths with a location.  But now, what's the cause?  Could the well water have something to do with it?

To find out you tell everyone to draw water from the other will in the woods - its inconvenient but the water's good and the deaths associated with the old well diminish - people still die but there is no apparent concrete cause like the well.

So for medical ads we now have an analogy for "risk."

There is a known risk with drawing water from the well in the clearing.

The root cause is unknown be there is demonstrable showing that time around the well is hazardous to your health.

So to conclude this portion of my post here is the question for you to think about for next time:

Why do more villagers die when taking water from the well in the clearing?

What could a village do to increase or decrease their risk of death?

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