Category: Health Psychology

Is Believing In Conspiracy Theories Delusional???

Okay, this is not the kind of issue I usually blog on. BUT. With surveys indicating that about half of the U.S. population believes at least one conspiracy theory, I think this Medscape Psychiatry piece deserves our attention. If we are going to truly understand Health Psychology in order to do our jobs in the healthcare marketing vertical better, we need to explore the outer fringes.  

Why is it important to understand that believing in conspiracy theories is not a mental disorder? Consider the widespread “Vaccine Hesitancy,” manifested in large percentages of the American public refusing to receive the COVID-19 vaccine. Reasons offered by people of this mindset include “They’re trying to alter my genes” and “They are installing trackers with the vaccine that will let them find me anywhere.” SO. As this article clearly explains, we can either throw up our hands, say “You’re crazy” and walk away, OR we can understand the way such illogical thinking develops and help people to work around it and get vaccinated. 

Bottom Line. Ten years ago, we didn’t  talk about “conspiracy theories” very much. Sure, there was talk of a conspiracy to kill JFK, and maybe the moon landing was faked. BUT. It was not part of our daily conversation, like it is now thanks to QAnon, etc. The rise of social media is clearly playing an important role here.  

My prediction? Conspiracy theories are going to continue to grow in importance in the national psyche. If we are going to successfully communicate with, and market to, people believing in these theories, we need to understand both their rationale AND how to deal with them.  

Should We Scare Them???

Check this out. What you will see is a continuation of the riff, started in my previous post, on the topic of how to create impactful public health messages. Translated, how do you mount a communications campaign that gets people to do something important for their health?

Yesterday we talked about the important role that “community leaders” can play in getting the masses to accept your public health message. Today’s URL carries you to the CDC’s elements for their anti-smoking campaign. Check out one or two of the videos offered at the top of the landing page. What you will see are the ravages of smoking-induced cancer, asthma, etc. as presented by the affected patients themselves. Compelling? They are to me! But how about to the masses?

Study after study has demonstrated that scary statistics, e.g. increased death rates, don’t do much convincing. Behavioral Economics teaches us that recipients of such messages simply employ “heuristics,” decision rules, to tune such negative information out using the “Yeah, but it won’t happen to me” line of reasoning. But how about these personalized vignettes, shared by people with holes in their throats wearing oxygen masks? How impactful are they with the average Joe/Josephine?

Bottom Line. Creating public health messages that work is not an easy task. As demonstrated over the past two posts, such messages need to be carefully customized based on such considerations as the behavior in which we want the message’s recipients to engage/not to engage, and the (sub)culture of which the recipients are members. Credibility is the name of the game here. 

My friends, there is a body of knowledge that speaks to such issues. It’s called “Health Psychology.” There are many good textbooks on this behavioral science.  During the pandemic era, where so many health outcomes are being determined by populations complying/not complying with public health messages, you might like to go read one. Or maybe even two.

The COVID-19 Vaccine Trucks Are Ready To Roll

Check this out.  What you will see is the announcement that McKesson has been tapped as part of Operation Warp Speed to do the distribution of the COVID-19 vaccine once one (or more) gets approved. As we have talked about before as it pertains to the pharmaceutical industry, this role could constitute a major PR plus for McKesson, a company that recently has been best known for its role in the U.S. opioid crisis.

Bottom Line. It is good to see that the Government is being proactive here. Hopefully, they are also developing the marketing communications programs that will help to ensure that sufficient numbers of Americans receive the injection. As a health psychologist, I am paying close attention to this issue. A recent post from a blogging physician, for example, asked of his colleagues the rhetorical question “Would you give a COVID-19 vaccine developed at “warp speed” to your child?” The clear implication? Nope!!!

Communications surrounding the pandemic have been less than crisp to date. Hopefully, the government’s communications about the vaccine will do a better job!

Unmasking Mask Craziness

Check this out. What you will hear are the rants of several enraged citizens to Palm Beach County’s passing of an ordinance requiring the wearing of masks. You know, Palm Beach as in Florida, where COVID-19 numbers are zipping past records set by NY State.

Spend 3 minutes and listen to the rants. Why? Simple! In recent months, we have heard the question “Why is the U.S. doing so poorly in controlling the pandemic?” with increasing frequency. Clearly there are many valid answers to this question. BUT. As you reflect on the “comments” of these women, like the assertion that masks kill people,  you will get a good feel for the importance of “disinformation” in contributing to this unfortunate outcome.  

But wait! After listening to the women, stay tuned for the doctor who opines that masks don’t do anything to protect the people wearing them. I’ve always been a little confused on this point. If that’s true, why do doctors and nurses unanimously consider a mask to be THE most important element in Personal Protection Equipment?

Bottom Line. People, what we have seen from the very beginning of the pandemic in the U.S. has been the violation of virtually every key principle of Healthcare Psychology. That body of knowledge maintains that in order to influence people to make good healthcare decisions, we need accuracy and consistency in what people are being told. And it has got to make sense. AND. It has got to motivate behaviors that would improve the COVID-19 numbers.  

So far, listening to these women and the doctor’s comments, it seems clear that we have succeeded at none of the above!

Small Copays, Major Impact!!!

Here is an interesting article with a simple message. Even a “small” copay can have a deleterious effect on patients’ adherence to a medication regimen. The larger the copay, though, the larger and more deleterious the impact. This is certainly true in diabetics’ use of insulin, which has gotten a lot of press lately. Amazingly, it’s also true in oral contraception and oral therapies for cancer!

Perhaps the clearest graphic presentation of this issue can be seen in the comparisons across countries graph shown in this article. The non-compliance rate due to drug cost in the U.S. looms over that in every other country where patients are expected to contribute significantly less of a drug’s cost.

Bottom Line. Study after study that we and others have conducted have demonstrated that there are myriad reasons for nonadherence to drug therapy. Side effects, patients not wanting to be reminded that they are sick, the inconvenience of having to return to the physician to get a prescription renewed, etc. BUT. The practical issue of drug cost remains a significant one in the big picture.  

While this article makes the point that there is a logic to having patients pay some of the cost of drugs so that they don’t seek “unnecessary health care,” the societal expense of the negative health outcomes of cost-related non-adherence also needs to be considered.

How do you strike a balance between these two rationales? Apparently, other countries do a better job of this than we do!!!

Rating The Ratings

Check this out.  What you will see is a doctor who is clearly and understandably disenchanted by the extent to which everything in healthcare is now being “rated,” and the extent to which these ratings are being used as the basis for non-trivial purposes like driving compensation. Great vignettes here. Like medical students who were served cookies during one of their classes rating the class experience as being significantly better than those students who weren’t given cookies. And patients who received a prescription from a telemedicine physician being significantly more likely to rate that doctor highly than patients who didn’t get a prescription, even though the Rx was likely for an unnecessary drug. Etc. Bottom Line. I think the doctor has a very good point. You may recall that I have questioned this whole ratings deal in healthcare many times before. In psychometrics classes I took as part of my doctoral training in psychology, I learned about ratings. I learned that they are easy to administer. And provide nice, quantitative data. And are unreliable. And are subject to the “halo effect.” And…. When this whole ratings fixation thing came into vogue, I thought that it would be a passing fancy. That it would come and go. That it would sink under its own weight. Nope! What might straighten this out? How about teaching the healthcare decision makers who keep wanting more ratings the basics of the psychology of how ratings actually work? And don’t work.  That might help! 

FDA Study Finds Patients Are Better Off With Simpler DTC Ads

Law 360 This one won’t take us long, folks. This URL only takes you to a study summary unless you are a subscriber. But, due to the commonsense nature of the study findings, I am guessing that is all you will need.  It seems that the FDA, once again demonstrating its penchant for proving the obvious, has found that patients can be overwhelmed by overwhelming amounts of side effect information in DTC advertisements for prescription products. Duh! Bottom Line. People, this is getting silly. The more I see TV advertisements for drugs to be used in Oncology, Cardiology, Rheumatology and other complicated therapeutic areas, the more I am overwhelmed by peoples’ absurd belief that we need to give patients enough information about drugs’ side effects for them to make an informed treatment decision about using the drug. Missing in the ads are such little details as the efficacy of the drug up against other therapeutic options, relative incidence and severity of side effects against the other options, etc.  OH  Also missing is the realization that all these advertisements were ever designed to do was to get the patient to ask her physician about the product, NOT to let her make the prescribing decision herself.  Why are we giving patients these silly lists of side effects, including such informative phrases as “some of these may be fatal?”And then spending tax payer dollars to study whether viewers are informed or confused? Why indeed?

“Patient Bias???”

Screen Shot 2017-08-10 at 6.08.13 PM Today, a little more on the “Health Psychology” theme we talked about in our last blog. Check out this post. Then try to figure out whether it is physician bias, or patient bias, that accounts for more of the good and the bad behavior we see in the treatment world. Obviously, a trick question. What really cooks the stew is when physician biases interact with patient biases in the treatment setting. Take “action bias,” i.e., the desire to do something, anything, that we talked about recently in our post about antibiotic abuse. Who has the action bias? Both the patient, who wants something done for her condition now, and the physician who wants to please the patient with an Rx and likely end the office visit by doing so. Bottom Line. Actually, this time it is a BTW. Let me remind you that the seminal book referenced in this post, How Doctors Think, is a must read for anybody in our vertical. I’ve mentioned this one before. If you didn’t read it the last time that I commended it to you, this is your second (But probably not your final, it’s that good!) notice. So, download this puppy to your Kindle and read it. Now!

The Psychology of Antibiotic Abuse

Screen Shot 2017-08-05 at 7.01.49 PM Yup. You read that right. Antibiotic abuse, not opioid abuse!!! Check out this article. Duh! What you will see in this piece is the revelation that there are multiple/documented reasons for physicians overprescribing, and patients over requesting/consuming, oral antibiotics. As I have been preaching for a long time, there is a body of knowledge, Health Psychology, that needs to be carefully drawn upon to understand behavior here, and to intelligently craft plans to change it. First, we need to understand that consumers don’t act any more rationally in healthcare than they do in any other segment of their lives. There are considerations like the “action bias.” I have a chest cold with a bothersome cough. I want to do something about it, damn it! Now!!! And “discounting the future.” I have that cold now. What do I care if by prescribing an antibiotic for me, which I will probably take half of, my doctor and I are screwing up antibiotic efficacy for future generations? As the authors sagely summarize, another educational poster is not going to alter this manner of thinking! So, what does Behavioral Psychology say will make a difference here? Suggestion. Physicians are competitive. Enter them into competition with their colleagues and offer feedback as to which doctors are prescribing antibiotics most conservatively.  Studies indicate that seems to work! Bottom Line. People, we need to get over the notion that simply giving people information and dire predictions of some outcome in the distant future will influence health behavior. Everybody, and I do mean everybody, in our vertical should have on their shelves for easy reference copies all of the books referenced in this article. Maybe everybody should even read them. If they did, they would get a great start toward understanding Health Psychology, and how this body of knowledge can help us to help patients behave better in the management of their healthcare.

No Kidding!!!

pill bottle Check out this recent study reported in JAMA.  As I have been saying for years, parlor tricks like “connected pill bottles,” social media support and other gizmos have been found to have no effect on patient adherence. DUH! A brief review. After decades of conducting psychologically-based marketing research for drug companies, spending millions of dollars of their money to understand adherence, I think I get how this works. And how it doesn’t work. In study after study, doctors told me that there are three kinds of patients. About one third of patients will comply with their medications on their own. Period. I am one of them. Having seen my father die in front of me from a myocardial infarct at the age of 59, I take my antihypertensive medication religiously! No gadgetry or social media encouragement needed. At the other end of the spectrum, about 33% of patients won’t comply no matter what you do. You have seen these patients. Pardon my political incorrectness as usual, but think of the 300-pound couch potato who gets no exercise and eats nothing but junk food. Logically, why would he bother to take a little white pill? Because his pill bottle beeped? We are left with the patients in the middle. When interviewed, some of these people tell you that they don’t want to take pills because doing so reminds them that they are sick. Others tell you flat out that they can’t afford the medication. For others, the trip to the pharmacy to refill the prescription and the trip to the doctor to renew the prescription are overwhelmingly inconvenient. Etc. Virtually every patient in this middle group has her unique set of “reasons” why drug compliance is not for them. Getting patients in this middle group to comply involves removing the specific barriers that are important to them. NOT trotting out an electronic pill bottle connected to an app. As I read this article, therefore, several things popped out at me. First is the comment that this study found that several “promising” technologies had been found not have any effect on adherence. Given the discussion above, why would anybody consider an electronic pill bottle to be “promising?” Also, I wince at the riff by one commentator who thought that the failure may have been the result of the poor design of the pill bottle used. A better pill bottle might have worked? Really??? Bottom Line. Let me try this again. There is a body of knowledge that we have talked about before. Healthcare Psychology. There are text books! We need to read and understand them. Doing so will help us to avoid doing stupid stuff like hooking pill bottles up to our iPhones and thinking that doing so is going to get patients to adhere!