‘Because an appeal makes logical sense is no guarantee that it will work.’ Bill Bernbach

Muzeable Thinking No.23 posted by Tim Brooks 18th July 2017

It’s a near miss.

No, not Bill’s quote[1]. That’s fab. Spot on. The near miss follows…

A week or so back an interesting and important new piece of research was published by The Academy of Medical Sciences entitled ‘Enhancing the use of scientific evidence to judge the potential benefits and harms of medicines.[2]’ It raises a host of critical issues, but in the end, relating to communication with the ‘general public’, it almost misses the point.

The research’s key soundbite – which BBC Radio Four’s Today programme focused on – is that ‘one-third (37%) of the public said they trusted evidence derived from medical research, but around two-thirds (65%) trusted the experiences of friends and family’. The report runs to 116 pages and goes well beyond a soundbite and makes valuable and relevant recommendations, 12 in all.

Think about it. It has to be scary that only a third of us trust medical data – even the good stuff – yet two-thirds of us trust in anecdote. Though, as a brilliant medical director I worked with often said… ‘Tim, the plural of anecdote is… data!’ Seriously, whilst reported outcomes produced in a clinical context are relevant and undervalued[3], friends’ data has usually gone through a complex filter of Chinese whispers, myth and misinterpretation before it lands i.e. it can be critical/valuable, but it is a curate’s egg/lottery.

Moreover, for data produced by the pharmaceutical industry it reports a staggering 82% of GPs and 67% of British adults ‘agreed with the statement that clinical trials funded by the industry were often biased to produce a positive outcome.’ Worrying, since industry funds much of the new research.

‘Houston, we have a problem’. So, why does this positive piece of work almost miss the point?

Well… although it starts by acknowledging the behavioural/real world component of the ‘issue’ and that healthcare systems often ignore people’s actual needs, it then repeatedly reverts to a solutions framework that focuses on education and rationally-based solutions to change the outcome. The argument is that better information and clearer presentation will change people’s acceptance of science per se and, ultimately, make us all more rational. Doh. It simply will not work. It is an example of expecting a better version of the wrong solution to deliver dramatically different results.

To change this, we need to start and end with a 100% focus on responding to real world needs/behaviour. People doubt experts [witness recent political upheavals] for many reasons, but most of them are fast, emotional responses, built on doubt, fear, mistrust and denial, NOT usually an intellectual inability to understand a rational message.

Of course, we need better/more consistent data that is better presented, but we also need a step change throughout our whole clinical, medical and regulatory framework. Don’t just ‘acknowledge’ real world behaviour – construct the entire universe around it. The ‘data’ has no role other than to enhance/facilitate this[4]. This is scary. But don’t hold your breath, because the health eco-system is still founded on a deeply paternalistic [with a capital ‘P’] world view and here lies the problem.

So, implement ALL the great recommendations around improving the data/presentation, but reconsider the desired end game. Stop seeing the output as a more rational – homo pharmaceuticus[5] – general public, making informed decisions. THIS IS ALMOST CERTAINLY A NAÏVE THEORETICAL CONCEPT. It will never happen. Reason? End users are not interested in the data per se, but in the benefits/ experiences/outcomes they receive and how this meets their needsas they see them. Until we approach public/health data through this lens we will never change anything.

Take packaging and labelling – a personal passion. It’s bad enough in prescription medicines, but in OTC/self-medication, where we are asking people to make their own choices, often at a supermarket shelf, it would appear that the MHRA [Medicines and Healthcare products Regulatory Agency] has never actually met a real person, let alone tried to understand how they behave and feel about their needs. We need even more fundamental changes than this paper’s sensible ‘Recommendation 8’. We must start with needs – not active ingredients, doses, pharmaceutical forms and modes of action etc[6]. [arghhhhhhhhhhhhhhhh!] – as the user would express it and stating benefits in their language. And yes, sometimes this might start to sound a bit ‘unscientific’ or ‘promotional’, but so be it if it helps people and gives no-one an unfair commercial advantage. This is fundamental, not a tweak from the excellent Plain English Campaign[7] or PIF[8]. [NB totally agree on a UK equivalent to US Drugs Facts Box… people would appreciate it, we’ve even done the research and have developed a working style guide available to those who are interested!]

All of this requires one particular group to change more than any other – medics, regulators and academics. It is a gross, unfair generalisation, but they need to stop telling us to be more rational and do the right things – e.g. losing weight, giving up smoking etc. and dramatically change THEIR approach to making it happen. Work harder to make their input more – sometimes, even at all – relevant to its recipients. I think it was Dale Carnegie who said ‘that people buy what they are buying, not what you’re selling’ – it was never truer here. Let’s start with what people are buying.

Rant over. Well done AMS this is good work and we hope it sparks change/debate, but until we truly, madly, deeply put PEOPLE @ THE HEART of our healthcare debate – especially in self-medication situations – we will only move at a snail’s pace. If that. If at all.

And finally, a plea. The people who can really make this change happen are rarely asked to contribute. The medical community/MHRA/academics generally see them as personas non-gratis; they look down their noses at them; they don’t trust them; they are not represented on the oversight committees; they are ignored. But, it’s the tawdry old commercial marketing community who is the most qualified to change people’s behaviour. Aggressively protect people from lies and sharp practice, but beyond that we need to let business talk to people about healthcare solutions without one hand tied behind their back. It’s another near miss.

 

 

 

[1] Bill Bernbach one of the true greats of advertising and communication. The agency that bears his name is still going strong. http://www.ddb.com/BillBernbachSaid/more-about-bill/biography.html

[2] https://acmedsci.ac.uk/more/news/action-needed-to-prevent-confusion-over-medicines

[3] Our current crusade on new ways to produce breakthrough claims reflects this. http://www.muzeable.com/muzeable-thinking/join-the-revolution-new-ways-to-deliver-breakthrough-otchealthcare-claims

[4] Obviously, much data exists, beyond this context, in a purely scientific/academic environment and contributes beyond patient information.

[5] Muzeable blog on self-medication and homo-pharmaceuticus. http://www.muzeable.com/muzeable-thinking/page/3

[6] NB this/safety data is VERY important, but only needed/helpful on the back of pack; leaflet… not front of pack.

[7] http://www.plainenglish.co.uk/

[8] Patient Information Forum https://www.pifonline.org.uk/

 

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