In the books Thinking Fast and Slow by Daniel Kahneman and The Master and his Emissary by Iain McGilchrist, the authors explore the workings of the human brain. I think we can use their insights to help build #AHealthierNation, especially if we consider the workings of the Human Brain Vs. Pharma TV Spots.
Both authors point out that our brains are hot wired to detect danger before safety. We detect anger in others before joy. This extends to images and words, even those in abstract of a lived experience. For example, we can detect an angry face in a picture of a crowd of happy people faster than we can detect a happy face in a crowd of angry people. The mention of a word associated with danger, even in absence of that danger in the present lived experience, triggers lightning quick brain activity associated with a threat. This has been studied and documented with MRI data.
Kahneman points out the we live our lives as stories, collections of experiences and memories that ideally come to a happy finale, and this is what we remember. In a particularly interesting chapter, he explores the idea of duration neglect and how as humans, we will willingly endure protracted and difficult experiences if the goal, outcome and future memory would be a positive gain.
One example he explains is that of amnesic vacations. An oversimplification; the duration of a vacation ideally has an effect on its quality. I think we’d all agree that 6 days are better than 3. But if the last day of the 6-day vacation is a poor experience, the overriding memory will be one of an unhappy vacation, despite the duration. This is the peak ending and most dominant lasting memory. For more on this you can watch his TED talk here.
Both of these books are fascinating and entirely different, but with many corollaries that make them worth reading. The Master and his Emissary makes clear the right brain is dominant in the role of detecting the incongruent, new, exciting and dangerous. The left brain is dominant in breaking it down into known bits of lived experience and cataloging it so as to help us detect the new vs the known, different or dangerous. There is a mysterious beauty to the power of this duality and the yin-yang balance that it achieves to help us detect danger and feel safe. You can watch him illustrate this in his TED talk here.
If we apply these findings of the workings of the human brain Vs. Pharma TV spots, it would suggest that ending a commercial with 30 seconds of “fair balance” that rattles off all the negative potential consequences of the therapy is not a good idea if we want people to seek out, consume and adhere to that treatment. What memory are we left with? What is the cumulative effect of these negative associations to the psychology of Americans, to what is now decades of exposure to often potentially life threatening consequences of treatment? We are putting our minds on high alert and then leaving ourselves with negative memories.
The FDA lives a paradox of endorsing the use of effective therapies that are proven safe and at the same time controlling how they are promoted.
The use of Fair Balance was deemed a reasonable solution to keep some checks and balances in the system. One early justification for direct-to-consumer advertising for healthcare products was that it would help make people healthier by helping them recognize health issues and solutions to what is ailing them. That said, I would argue it is not working entirely as hoped. Direct-to-consumer advertising has certainly proven to sell more drugs but is it really helping? Adherence and compliance rates remain terrible. As a nation we are not among the healthiest, despite having the one of the best healthcare systems in the world. I can’t help but feel that there exists an unintended and negative consequence of bombarding our culture with therapy risk profiles instead of more positive educational messages about living a healthy and happy life.
I’m not suggesting that the problems of adherence and compliance have been caused by advertising, they certainly predate it. What I am suggesting is that advertising executed in this way has become just another part of the problem and it’s time to consider alternative approaches that not only make us aware of solutions but improve long-term outcomes for #AHealthierNation.
Advertising is part of the brand experience and nobody wants to experience side-effects, even in the abstract. Patients need to be educated about the potential risks of any treatment and there are other and potentially better ways to provide this learning. Awareness advertising by its very nature employs both reach and frequency to achieve its goal. The persistent drumming of risk factors in combination with how our brains are hot wired to detect risk is a perfect storm. Our abilities to detect risk and the frequency of exposure caused by this type of advertising may be creating strong negative associations with these brands specifically and perhaps more detrimentally, pharmaceutical therapies overall.
On any given night during a TV commercial break it is not uncommon to see 2-3 pharma spots back-to-back. This results in approximately 1.5 minutes of nausea, hives, Arrhythmia, trouble breathing, night sweats, diarrhea, dizziness, life threatening rash, allergic reactions, suicidal thoughts, dry mouth, internal bleeding, increased blood pressure, stroke, liver damage, heart attack and other potential drug-drug and dietary interactions that in rare cases have caused death.
This parade of alarm bells is made no less volatile by the mostly generic visual backdrop of smiling happy people and the sometimes over-qualified claims of efficacy. Remember we’re hot wired to detect risk before all else. How’s that for a side effect? Human Brain Vs. Pharma TV could be a perfect storm of unintended consequences. June 2014 saw the beginning of OpenFDA an effort to make accessible the FDA database of side effects, drug labels, warnings, food recalls. This project is still in Beta but it holds great promise to help us better manage and understand the insights available through this repository and how insights gained across drug and device class can inform #AHealtherNation and perhaps will give us opportunity to create better, more positive and educational TV spots.
As communicators we can do better to create a #AHealthierNation and support our Physicians and other healthcare workers to help us live healthier lives.