E-drug: Reply to Dr. Srinivas from Dr. Attaran (cont'd)
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I would like to address the issue of how to communicate with health
professionals about the evidence that shows that we are adversely
influenced by drug promotion.
It is common and understandable for health professionals to perceive
this as an attack on their self esteem and thus to react with denial eg:
I am invulnerable to being mislead because I am intelligent and/or
well trained.
A recent study suggests that dispelling this illusion of invulnerability is
the key to learning how to avoid being mislead:
Sagarin, B. J.; Cialdini, R. B.; Rice, W. E., and Serna, S. B. Dispelling
the illusion of invulnerability: the motivations and mechanisms of
resistance to persuasion. J Pers Soc Psychol. 2002 Sep;
83(3):526-41.
I find it helpful to make the following 9 points:
1) I am intelligent enough to pilot a plane but I have no relevant
training. Do you want to come for a ride?
2) Evaluation of drug advertising requires advanced skills in
psychology, informal logic and marketing as well as epidemiology and
statistics.
3) We don't have the time, let alone the skills, to evaluate drugs and
often much of the information required is not available. Consequently
we use decision making short cuts - eg trusting experts.
4) Advertisers have been doing controlled trials of promotional
techniques since the 1920s. They know what works. They know how
to trigger our shortcuts - eg magnify the voices of the most favourable
experts.
5) "The system" pays drug companies more for increasing sales of
more expensive drugs regardless of health outcomes. They have little
choice but to do what works or be taken over by a more aggressive
competitors.
6) Increasing misleading promotion leads to increased drug sales.
Increasing drug sales rewards and funds increased misleading
promotion. It's a vicious cycle.
7) Health professionals' levels of acceptance of information from drug
companies varies greatly. The evidence shows that the most
accepting tend to be worst prescribers.
8) The general public is increasingly concerned that our reliance on
drug companies undermines our capacity to give advice that they can
trust. If we have no credibility then why should they pay us? (This
point is very important for motivating self-styled pragmatists.)
9) It makes it easier for patients (in this case health professionals) to
accept the diagnosis/problem if you give them information about
treatments/solutions at the same time. The solution involves health
professionals joining organisations such as
www.healthyskepticism.org and www.nofreelunch.org
regards,
Peter
Dr Peter R Mansfield
GP
Research Fellow, Department of General Practice, Univ of Adelaide
NHMRC Public Health Postgraduate Scholarship 250465
Director, Healthy Skepticism Inc
Improving health by reducing harm from misleading drug promotion.
E-mail: peter@healthyskepticism.org
www.healthyskepticism.org
34 Methodist St, Willunga SA 5172 Australia
ph/fax +61 8 8557 1040
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