So, how can you, as a patient, know when you've been given a poor reason
for treatment? This is unfortunately not easy. There is so much mis-information
and opportunistic marketing out there that it's often hard to know who to
I have just finished reading a book by Michael Shermer titled "The Mind of the Market." It was an excellent read and I'd recommend it to anybody interested in human behaviour or even the economy (a hot topic!). This post is to expand on what is meant by opportunistic marketing.
There is a lot of information in the book about why we make some of the decisions that we do. One particular bit of information seemed particularly relevant to this blog, and I'll attempt to explain how. From p. 97:
Thousands of experiments in behavioral economics demonstrate conclusively that
most of us are highly risk averse.
How risk averse? According to research we are about twice as motivated by a risk of loss than we are a potential for gain. Further research has confirmed that most of us are actually wired to think this way. For every tendency in human behavior there is a matching strategy to capitalize on it by others.
Since we are typically more motivated by risk of loss many marketing strategies exist to point out to you exactly what you stand to lose if you don't buy their product, do as they say, follow thier advice, seek their care, etc. I'm sure you can immediately think of several examples. This strategy exists in healthcare too. Healthcare decisions often involve the need to motivate patients to action. This research clearly shows that it is more motivating to say "If you don't exercise you may fall into a state of poor cardiac health and risk heart attack and stroke" than it would be to say "Exercising helps you feel better, is good for you heart and lungs, and will make you feel more energetic!" Again, we are more motivated by a risk of loss than a potential for gain.
Unfortunately, opportunistic marketing exists in healthcare just as it does everywhere else. Thinking in terms of risk aversion, be on the look out for products or people who are trying to convince you that you have a problem, and the problem is a lack of whatever it is they are selling. The nutritional supplement industry is full of this type of thing.
Sometimes, however, it is appropriate to be told what risks your behaviors carry. For example, "If you don't stop smoking you risk getting lung cancer, having a heart attack, and/or having a stroke" would be very appropriate to hear from your physician if you smoke. This is appropriate because it has been shown to be true in quality research and the behavior is present.
You have to be on the lookout for mis-information though. This is not easy and we'll be getting into some ways of doing this effectively in future posts. For a start, any claim that is made to you by a healthcare provider should be able to be backed up in a science based way. At a minimum it should be plausible and optimally it should have specific research to back it up.
This is one of the big problems with people who are in pain, however. The research on specific treatments has been either a) lacking, or b) typically of questionable quality (although this is turning in the right direction). I commonly hear from both collegues and patients that you can find research that will agree with just about anything. That is true, but you can't find QUALITY research that agrees with anything. For research quality we often must rely on others help. I find this site to be of great help. But, in absence of quality research we must rely on plausibility. And this you can learn to identify. More coming soon....