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Monday, January 23, 2012

The Art of Medical Deception (Part III)

So now we have a "risk" but the detailed mechanism of why they are dying are unknown to the villagers.

But there is still a definite "risk."

A "risk" just like finding out that people who have higher cholesterol also get heart attacks in ads these days.

But that does not mean the two are directly related (risk does not imply cause).

The sniper might be killing them because they are easier to see in the clearing, for example.  Or because light reflects off the surface of the water being fetched. Or because those who use that particular well wear colorful clothing that makes them easy targets. Or for any other number of mysterious reasons.

No one knows except the sniper and he is not telling.

So next we have the "patent medicine man" who comes to town. He discovers the research about the well so he starts selling bottled water.

No more need to go to the well.

And the million billion trillion dollar question is: does the bottled water really reduce your chance of dying?

Now let's remember risk is a predictor of something, a chance, as I wrote about "Cholesterol, Heart Disease, and Magical Thinking" - its not concrete.  So to talk about risk we have to look at the population of the village, the number of deaths, and the places where people went, i.e., the well.

So if over a year seven people die in the village (both from the sniper as well as other causes) then there is a 7% (7 out of 100) risk of death.  So let's say that four people die by the well, or a 4% risk.

So 4% divided by 7%, which gives our epidemiological risk, is a 57% risk of going to the well and dying.  But that's only if you're going to die.

Wow, not sure I would want to go to the well with that level of risk.  But that's not the "chance" I would die - its the potential increase in chance from dying in general over dying by the well.

So let's think about how this works in advertising.  A 57% risk of something bad is pretty scary.  People easily deal with small risks, .01% in things like sky diving, mountain climbing, and so on.  But 57% is almost 2 out of 3.  That's because the chances of actually dying in these situations is small.  But these ads don't talk about chances because they are unknowable in this context and everyone has a 100% chance of dying - so that's not news either.

So the ad starts out by talking about something bad - in the case of our village dying when you go to the well.  "System 1" as defined by Kahneman will immediately pick up on this because its a threat and one of "System 1's" jobs is to react to threat.  "System 1" cannot differentiate between "risk" and "chance" in this context.  ("Danger" - whether there is a risk or chance - is simply bad as far as its concerned.)

So the first thing the ad does is get our attention because it scares us, or rather, our "System 1".

Next the ad will say something like "Our bottled water will reduce your risk of death."

Now in the sense of "truth in advertising" they will say more (either very fast or in small print) but not in a way "System" 1 will notice - and this is on purpose.

So "System 1," who feels threatened, will pick up on the solution to its fear: "reducing risk".

"System 1" hears this and things "I better by this bottled water so I can be safe."

In truth its unclear whether this will actually reduce your chance of death or keep you alive longer.  For one thing, we don't know why the sniper likes the well - their can be many reasons: clothing, actions, the fact that there is a clearing, and so forth.  And in fact we don't even know that it will make you safer - we know that "things staying as they are" if you go to the well less often then you may have a reduced chance of dying.

Its not that you will have a reduced chance - you might.  The bottled water changes the ratio of the 4%/7% but the sniper doesn't know or care about those numbers.

So this is quite a bit different that showing pictures of "sizzling pizza" to make you hungry.

If you eat the pizza you will be less hungry - "System 1" knows this too.

Your chances of dying may not be changed by drinking the bottled water.

But that's not what the ads make you think.

And that's simply lying.

Yet from "System 1's" perspective the two types of ads seem the same: purchase X and gain satisfaction.

Personally I think ads based on the adjustment of "risk" should be banned.  The cause of heart attacks is not cholesterol - its inflammation.  This is well known to the medical community but you would never know based on the TV ads.

I think that the old FCC was right to ban this type of ad in the past.

People are not equipped to understand the notion of "risk" as defined by "Big Pharma."

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