Small Effects, Fear, and Confusion
13th August 2010
Ambiguity is persuasion’s best friend. When you are uncertain, persuasion principles drive your thinking, feeling, and acting. If you doubt this, consider health and safety, or more properly nowadays, Health and Safety. I’m going to take one example, use it to kick open a door, then drive a truck through it.
Statins.
Those wonderful little pills that reduce cholesterol, have virtually no side effects, and help everyone to live longer and healthier lives. Except that’s not true. Not even close. The original research demonstrated that among people with existing cardiovascular disease, statins did help, but at a rather small effect. Now add in fear (of death) and confusion (among patients and doctors), and soon almost anyone was taking a statin. Instead of acting as a curative agent that reduced disease in sick people, statins became preventative agents that reduced the risk of disease ever starting in healthy people.
But the data never supported that shift from cure to prevention and today even the medical establishment is beginning to say it loudly out loud. Journal Watch reports a nice summary of recent summary studies on statins. Let me quote the headlines and the lead paragraph.
Statins and Primary Prevention for Patients at High Risk for Heart Disease.
The benefit, if any, is very small.
Statins – which clearly confer an all-cause mortality benefit in patients with known cardiovascular disease (CVD) – are prescribed extensively for primary prevention in patients at high CVD risk but without CVD.
The article then nicely summarizes results from several recent studies that demonstrates “preventative” statins had not even statistically significant effects on extremely large samples (68,000 cases!) in carefully controlled experiments. In other words, among people who were not sick with CVD, but at risk (smokers, hypertensives, obese, etc.) the statins had no effect on mortality. And, doctors prescribe and patients take statins like the pills were breath mints.
And this is not news. If you doubt me, I’m not going to make the case here because you won’t believe me in a blog post. Read the research yourself. And read it. Look at the numbers. Think about the numbers. Find the absolute rates, not those Sophistical Statistics like relative ratios that persuasively inflate outcomes. And don’t look just at statins. Look at the persuasion on: vitamin D, omega-3, hormone replacement therapy, obesity, prostate cancer, screening tests. For people who are already sick, various interventions do produce helpful, real, if small, effects. But past that limited application, most of the Health (and Safety) research over the past 20 years operates more like persuasion than science.
Consider again just the instance of statins.
Even many children know that many people die of heart problems so that anything that reduce the chance is a Good Thing. And, if a little statin pill helps sick people, won’t it help not so sick people? If you don’t think carefully about it, the answer seems to be yes. So, when you visit a doctor and she says you might consider this little pill that is covered in your health plan, tastes like nothing, and is easy to swallow with your breakfast juice, why not?
Now, here’s the persuasion analysis.
The pill has no effect. You don’t know that, but because somebody in a white coat gave it to you, you think you are doing the right thing. And the right thing here is not thinking for yourself, but doing what someone else suggests. Thus, you are making external attributions (my doctor) rather than internal attributions (me) for your health. You don’t have to think. You can proudly stroll along the Peripheral Route cue-ing along with Credibility (your doc) and Comparison (everyone’s doing it).
Worse still, you are now also cue-ing with Commitment/Consistency meaning the next time your doc recommends something, say a screening test, you are more likely to comply simply because you did it in the past, so you need to stay consistent with that past commitment – taking a statin. And, maybe that next New New Thing comes in a pill and your kindly doc gives you a free sample which you use without thinking, then thoughtlessly continue with in a Reciprocity cue (your doc gave you something – the free sample – and you need to give something in return – a paid order covered under your health plan).
Small effects, fear, and confusion combine to make health and safety not a science problem, but a persuasion problem.
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