pharmaceutical advertisements

Thoughts on Pharmaceutical Advertisements

“The reality is that most people hear more from pharmaceutical companies (16 to 18 hours of pharma ads per year) than from their doctor (typically under 2 hours per year).” writes Dave Chase in his book The Opioid Crisis Wake-Up Call. Chase is critical of American’s looking for a quick fix and expecting a pill to solve their problems. He says that short doctors appointments and a bombardment of pharmaceutical advertisements on TV contribute to the mindset that any disorder or illness can be fixed in a matter of minutes with a quick pill. With how much we hear from drug companies, and how little time we spend with someone who is trying to work with us in depth to correct behaviors, change our thoughts, improve muscle imbalances, or make adjustments to help us live a more healthy lifestyle, it isn’t hard to understand why most people think of medical care in the form of a pill.

 

I am wary of pharmaceutical advertisements. I don’t really understand if I am the target audience or if medical professionals are the target audience. I’m not sure if the goal is to just normalize taking pills, or if the goal is to educate patients about a potential solution for a potential problem. I’m not sure if the idea is to get people away from taking generic medication in favor of brand name drugs, or if it is to get people to try a medication and see if it helps them.

 

However, I also remember seeing a study which suggested that drug advertisements did help improve people’s health literacy, and did lead to patients being more likely to ask about medications which would help them, without finding an increase in patients asking about medications that wouldn’t be helpful for them. `When primary care providers are stressed, have limited time with patients, and are likely to miss important details, having patients with goals and specific questions about beneficial medication is important for overall health gains and an improved doctor-patient relationship. Additionally, advertisements approved by the FDA and at least somewhat regulated are better places for people to gain medical information about a drug than a Reddit or Facebook post from a random person.

 

Ultimately, I think I fall on the side of banning direct pharmaceutical advertisements. I find they are overly broad, dangerously support the idea that all one needs is a pill to solve all health problems, and ultimately are more about pharmaceutical companies than about improving health in general. I’m not 100% sure this is the best course, but I’d put my confidence around 75% sure this is the best path to pursue. I don’t think it would hurt America to be a little less focused on pills as cures rather than focused on lifestyle changes, especially if we start to favor policy changes that would support more healthy lives.

An Illusion of Security, Stability, and Control

The online world is a very interesting place. While we frequently say that we have concerns about privacy, about how our data is being used, and about what information is publicly available to us, very few people delete their social media accounts or take real action when a data breach occurs. We have been moving more and more of our life online, and we have been more accepting of devices connected to the internet that can either be hacked or be used to tacitly spy on us than we would expect given the amount of time we spend expressing concern for our privacy.

 

A quick line from Tyler Cowen’s book The Complacent Class may explain the contradiction. “A lot of our contentment or even enthrallment with online practices may be based on an illusion of security, stability, and control.”

 

I just read Daniel Kahneman’s book Thinking Fast and Slow and in it he writes about a common logical fallacy, the substitution principle. When we are asked difficult questions, we often substitute a simpler question that we can answer. However, we rarely realize that we do this. Cowen’s insight suggests that we are using this substitution fallacy when we are evaluating online practices.

 

Instead of thinking deeply and critically about our privacy, safety, and the security of our personal or financial information in a given context, we substitute. We ask ourselves, does this website intuitively feel legitimate and well put together? If the answer is yes, we are more likely to enter our personal information, allow our online movements to be tracked, enter our preferences, and save our credit card number.

 

If matching technology works well, if our order is fulfilled, and if we are provided with more content that we can continue to enjoy, we will again substitute. Instead of asking whether our data is safe or whether the value we receive exceeds the risk of having our information available, we will ask if we are satisfied with what was provided to us and if we liked the look and feel of what we received. We can pretend to answer the hard questions with illusory answers to easier questions.

 

In the end, we land in a place where the companies and organizations operating on the internet have little incentive to improve their systems, to innovate in ways that create disruptive changes, or to pursue big leaps forward. We are already content and we are not actually asking the hard questions which may push innovation forward. This contentment builds stagnation and prevents us from seeing the risks that exist behind the curtain. We live in our illusion that we control our information online, that we know how the internet works, and that things are stable and will continue to work, even if the outside world is chaotic. This could be a recipe for a long-term disaster that we won’t see coming because we believe we are safely in control when we are not.

Two Messages

In The Elephant in the Brain Kevin Simler and Robin Hanson write about the ways in which we act to signal something important about ourselves that we cannot outright express. We deceive ourselves to believe that we are not sending these signals, but we recognize them, pick up on their subtle nature, and know how to respond to these cues even if we remain consciously ignorant to them. In the book, the authors focus on how we use these cues in language and communication.

 

The authors write, “Every remark made by a speaker contains two messages for the listener: text and subtext. The text says, ‘Here’s a new piece of information,’ while the subtext says, ‘By the way, I’m the kind of person who knows such things.’ Sometimes the text is more important than the subtext … but frequently, it’s the other way around.”

 

It is important to acknowledge that sometimes the text truly is the important part of our message. Because we occasionally have really important things that people need to know, and because that information outweighs the fact that we are the one who knows it and shared it, we can use that as a screen for us in this game of two messages. We can believe that all our communication is about important important information because there are times where the things we communicate are crucial to know. Hanson and Simler’s idea above only works if sometimes it is true that the text is the important piece and if almost always we can plausibly say that we are just trying to convey useful information as opposed to showing off what we know or what we have learned.

 

No matter what, at the same time our communication says something about us and about what knowledge and information we may have. It can also say something about what we don’t know, which may be part of why we go to great lengths to make it seem like we were not ignorant of something – our language/knowledge might tell people we are not the kind of person who knows something that everyone else knows.

 

Our language also tells people that we are the kind of person who cares about something, or has great attention to detail, is strict and disciplined, or is from a certain part of the country/world. Some of these signals are fairly hidden, while others are more clear and obvious. When we look more closely at the way we signal in our conversation, we can see how often our words are only part of what we are communicating.

Sabotage Information

“Our minds are built to sabotage information in order to come out ahead in social games.” In The Elephant in the Brain, Kevin Simler and Robin Hanson write about the ways in which we act out of our own self-interest without acknowledging it. We are more selfish, more deceptive, and less altruistic than we would like to admit, even to ourselves. To keep us feeling good about what we do, and to make it easier to put on a benevolent face, our brains seem to deliberately distort information to make us look like we are honest, open, and acting with the best of intentions for everyone.

 

“When big parts of our minds are unaware of how we try to violate social norms, it’s more difficult for others to detect and prosecute those violations. This also makes it harder for us to calculate optimal behaviors, but overall, the trade-off is worth it.” As someone who thinks critically about Stoicism and believes that self-reflection and awareness are keys to success and happiness, this is hard to take in. It suggests that self-awareness is a bigger burden for social success than blissful unawareness. Being deluded about our actions and behaviors, Simler and Hanson suggest, helps us be better political animals and helps us climb the social hierarchy to attain a better mate, more status, and more allies. Self-awareness, their idea suggests, makes us more aware of the lies we tell ourselves about who we are, what we do, and why we do it, and makes it harder for us to lie and get ahead.

 

“Of all the things we might be self-deceived about, the most important are our own motives.” Ultimately, however, I think we will be better off if we can understand why we, and everyone else, believe the things we do and behave the way we do. Turning inward and recognizing how often we hide our motives and deceive ourselves and others about our actions can help us overcome bias. We can start to be more intentional about our decisions and think more critically about what we want to work toward. We don’t have to hate humanity because we lie and hide parts of ourselves from even ourselves, but we can better move through the world if we actually know what is going on. Before we become angry over a news story, before we shell out thousands of dollars for new toys, and before we make overt displays of charity, we can ask ourselves if we are doing something for legitimate reasons, or just to deceive others and appear to be someone who cares deeply about an issue or item. Slowly, we can counteract the negative externalities associated with the brain’s faulty perceptions, and we can at least make our corner of the world a little better.

Our Brains Don’t Hold Information as Well as We Think

Anyone who has ever misplaced their keys or their wallet knows that the brain can be a bit faulty. If you have ever been convinced you saw a snake only to find out it was a plastic bag, or if you remembered dropping a pan full of sweet potatoes as a child during Thanksgiving only to get into an argument with your brother about which one of you actually dropped the pan, then you know your brain can misinterpret signals and mis-remember events. For some reason, our hyper-powerful pattern recognition brains seem to be fine with letting us down from time to time.

 

In The Elephant in the Brain, Kevin Simler and Robin Hanson write, “There’s a wide base of evidence showing that human brains are poor stewards of the information they receive from the outside world. But this seems entirely self-defeating, like shooting oneself in the foot. If our minds contain maps of our worlds, what good comes from having an inaccurate version of these maps?” 

 

The question is, why do we have such powerful brains that can do such amazing things, but that still make basic mistakes all the time? The answer that Hanson and Simler propose throughout the book is that having super accurate information in the brain, remembering everything perfectly, and clearly observing everything around us is actually detrimental to our success as a social species. Our view of the world only needs to be so accurate for us to successfully function as biological creatures. We only need senses that satisfice for us to evade predators, avoid poisonous mushrooms, and get enough food. What really drives the evolution of the brain, is being successful socially, and sometimes a bit of deception gives us a big advantage.

 

It is clear that the brain is not perfect at observing the world. We don’t see infrared wavelengths of light, we can’t sense the earths magnetic pull, and we can’t hear as many sounds as dogs can hear. Our experience of the world is limited. On top of those limitations, our brains are not that interested in having an accurate picture of the information that it actually can observe. We must keep this in mind as we go through our lives. What can seem so clear and obvious to us, may be a distorted picture of the world that someone else can see as incomplete. A good way to move forward is to abandon the idea that we have (or must have) a perfect view and opinion of the world. Acknowledge that we have preferences and opinions that shape how we interpret the world, and even if we are not open to changing those opinions, at least be open to the idea that our brains are not designed to have perfect views, and that we might be shortsighted in some areas. We will need to bond with others and form meaningful social groups, but we should not accept that we will have to delude our view of the world and accept alternate facts to fit in.

Our Devious Minds

We now realize,” write Kevin Simler and Robin Hanson in their book The Elephant in the Brain, “that our brains aren’t just hapless and quirky – they’re devious. They intentionally hide information from us, helping us fabricate plausible pro-social motives to act as cover stories for our less savory agendas. As Trivers puts it: “At ever single state [of processing information] from its biased arrival, to its biased encoding, to organizing it around false logic, to misremembering and then misrepresenting it to others – the mind continually acts to distort information flow in favor of the usual goal of appearing better than one really is.

 

Recently I have been pretty fascinated by the idea that our minds don’t do a good job of perceiving reality. The quote above shows many of the points where our minds build a false sense of reality for us and where our perceptions and understanding can go astray. It is tempting to believe that we observe and recognize an objective picture of the world, but there are simply too many points where our mental conceptualization of the world can deviate from an objective reality (if that objective reality ever even exists).

 

What I have taken away from discussions and books focused on the way we think and the mistakes our brain can make is that we cannot always trust our mind. We won’t always remember things correctly and we won’t always see things as clearly as we believe. What we believe to be best and correct about the world may not be accurate. In that sense, we should doubt our beliefs and the beliefs of others constantly. We should develop processes and systems for identifying information that is reasonable and question information that aligns with our prior beliefs as much as information that contradicts our prior beliefs. We should identify key principles that are most important to us, and focus on those, rather than focus on specific and particular instances that we try to understand by filling in answers from generalizations.

Sharing Knowledge

The informational age that we live in today is interesting. We feel (at least I feel) a great urge to share the knowledge we gain from reading, interacting with smart people, and by simply being present in the world. Personally, I have also almost always felt that I was supposed to have some type of an opinion about any given topic. The world, it seemed, always wanted me to say one thing or another and have thoughts about one thing, even if I didn’t know much about it.

 

In Letters From a Stoic Seneca briefly touches on this same point. He often started many of his letters in a build-up to the advice that he was passing along. One of those sections opening one of his letters read, “Nothing will ever please me, no matter how excellent or beneficial, if I must retain the knowledge of it to myself. And if wisdom were given me under the express condition that it must be kept hidden and not uttered, I should refuse it. No good thing is pleasant to possess, without friends to share it.”

 

Robin Hanson and Kevin Simler, in their book The Elephant in the Brain, explain why Seneca felt this way 2,000 years ago and why I feel this way today. They explain that communication is not really about sharing valuable information. If it was, we would only want to share our valuable information if someone else shared their valuable information first. In a sense, our society would be kick-ass at listening, and Ted Talks probably wouldn’t be a thing. What is really happening in our social worlds is that we evolved to show off. We want to show people how much useful information we have, what unique insights our experiences have given us about the world, and what new knowledge we have. Possessing new, unique, and helpful information 50,000 years ago meant that we could help ourselves and others survive. Sharing that information freely showed an abundance of knowledge and resources on our part, and made us a useful ally which helped us thrive in social groups.

 

We probably should not turn against this urge to share useful knowledge. Books, insightful anecdotes, and Ted Talks seem to have worked out pretty good for humans in terms of sharing and passing along useful information. We should recognize, however, that often the desire to share our knowledge is not as altruistic as Seneca might have you think. Our urge is a bit self-serving, so before we post on Facebook about how obviously correct our political views are relative to others, we should recognize the evolutionary forces driving us to have an opinion and encouraging us to blast those ideas out into the world in an attempt to show off. Ultimately, if you are going to share your thoughts, try to spend some time developing them so that they provide real value to the person who may encounter them.

Building Models and Examining the World and Our Thoughts

This morning listening to an episode of Conversations with Tyler, Russ Roberts, the guest on the show said something that really stood out to me, “I used to believe that…my models described the world, as opposed to gave me insight into the world.” We operate in a world where there is no way for us to ever have complete information. There is simply too much data, too much information, to much stuff going on all around us for our brains to perfectly absorb everything in a reasonable and coherent way.

 

You do not notice every blink, you could never possibly understand every chemical’s smell that makes up the complex aroma of your coffee, and you can’t hold every variable for that big business decision in your head at the same time. Instead, our brains filter out information that does not seem relevant and we key in on what appears to be the main factors that influence the world around us. We build models that sometimes seem like they describe the world with spectacular clarity, but are only a product of our brain and the limited space for information that we have. Our models do not reflect reality and they are not reality, but they can give us an insight into reality if we can build them well.

 

No matter what, we are going to operate on these models in our daily lives. We develop a sense of what works, what will bring us happiness, what will create well-being, and how we will find success. We pursue those things that fit in our model, toss those things that don’t fit in the model to the side, and somewhere along the line begin to believe that our model is reality and criticize everyone who has a model that doesn’t seem to jive with ours.

 

A more reasonable stance is to say that we have developed a model that gives us insight into some aspect of reality, but is open for adjustment, improvement, or could be scrapped altogether in favor of a new model if necessary. The only way to do this is to be an active participant in our lives and to work to truly understand ourselves and the world around us. The quote from Roberts on Cowen’s podcast aligns with the quote that I have from Colin Wright today. From Wright’s book Becoming Who We Need To Be I have a quote reading, “It’s not enough to just smell the fragrances that drift our way every day. We have to take the time to pull those aromas apart, to figure out what components go into them, and compare and contrast them with others. We have to be awake and aware, not just alive. We have to be participatory in our own lives, and give our mental capacities a reason to keep operating and expanding, otherwise they will, quite understandably, if we’re using biological logic, begin to shut down to save energy.”

 

Deciphering the aromas is a metaphor for understanding how we are interacting with the world and how the world exists around us. If we retreat to safety and comfort by believing that our models are correct and perfect, then we fail to improve our understanding of the world and our place in it. Our mind atrophies, and the potential we have for making the world a better place is continually diminished. Simply believing something because it benefits us, makes us feel good, and is what people similar to us believe can drive us and the world into an inefficient place where we fail to do the most good for the most people. There is nothing wrong with that world, it is an option, but if we believe that human flourishing is worth striving for and if we believe that we can help improve the living standards for ourselves and the rest of humanity, then we must use and expand our cognitive capacity to better understand the universe to improve the world for ourselves and the rest of humanity. Your model is incomplete and gives you insight into one aspect of reality, but you must remember that it is not a perfect description of how the world should be, and you must work continuously to build a better model with better insight into the world.

Remember Your Bubble

A huge challenge for our world today is the way we get stuck in our own echo-chambers and fact bubbles. The world is a large and incredibly complex place. We never truly know that much about any one thing. We might be an expert in our field of study, we might be an expert in the area we work in, and we might have a hobby that has made us an unofficial expert in a random thing, but we can never truly know everything there is about a subject or topic. As a result, we rely on a body of knowledge that is incomplete to make assumptions to form a belief about the world.

 

Colin Wright writes about these fact bubbles in his book Becoming Who We Need To Be, “We also find ourselves stuck inside fact bubbles which reinforce our existing ideologies, and which fail to provide us with full context, with complete, accurate information, and which leave us, as a result, holding worldviews that are not based on accurate representations of what’s happening.” This is not a new problem in human history, but it feels like it is a more acute problem today than it has been in the past. We have more access to information today than any humans before us, but the overwhelming tidal wave of information that we can focus on puts us in a position where we have to make choices about the information we take in. We can build a world for ourselves in which our worldview is always reinforced, and never seriously challenged. We can create a world in which all of our problems are blamed on some “other” who we must vilify in order to improve things. We advocate for specific ways that we think the world should organize itself because it is what we see, what we know, and what is familiar for us.

 

These bubbles however, are incredibly limited and our singular perspective does not accurately represent the complete range of experiences and possibilities for the human condition. As a response to these bubbles, many people advocate for stepping outside our groups and tribes to understand the worldviews and ideas of others. I do not think this is realistic advice.

 

The world is busy and we only have a limited amount of time and attention to direct toward any given thing. Trying to take in information that we can understand and identify is in many ways a by product of long work hours, long commutes, too much information to know where to focus, and a world that seems to place unlimited demands on our thoughts and actions. Rather than trying to jam in more time reading things that challenge us or listening to news that might spike our blood pressure, I instead advocate for more self-awareness. Recognize how frequently we act and are inspired by a story that makes us look like the hero. Acknowledge the times when you select something to read because it looks like it will already fit in with what you want to believe. Be aware that your perspective on the world is incomplete and that the information you absorb is limited and filtered to present the world a certain way. We likely won’t be eliminating bubbles from our lives any time soon, but we can at least acknowledge their existence and recognize that we don’t have the certainty we would like about the information that helps us know what is really happening in the world.

An Important Task

Scott Russel Sanders continues in his letter of advice for James Harmon’s book, Take My Advice, writing about self awareness, spirituality, and philosophical ideas.  Towards the end of his letter he writes, “To understand as well as we can who we truly are and in what sort of world we have been set down may be our most important task.”  What I like about this quote is that it takes away the importance of obtaining material things and addresses the questions or doubts that we all constantly sift through.  For Sanders, what he is showing in this quote is the value of objectively understanding ourselves, the world, and our place in it.
The first part of Sanders quote speaks to me about the purpose of self reflection.  Being able to think about what we are good at, what we enjoy and why, and what we truly want in life will help us find a path that is comfortable and appropriate for us.  This is a truly important task for each of us, because an increased self awareness will allow us to begin to live our lives intentionally rather than living in a reactionary way.  We do not have to chase the goals that our friends, the media, religion, and family tell us we need to chase. Self awareness and knowing who we are and what we truly desire will allow us to find a meaningful path to follow to a destination that we will be happy with.
The second half of Sanders quote seems to be a little more difficult in my opinion.  I have come across many people who write and speak about self awareness, and while the road to self awareness is bumpy and full of obstacles (especially when you first set out) the road to a true understanding of the world we are in is more challenging and subjective.  Self reflection (examining your goals, desires, motivations, and skills) takes practice and it can be hard to learn that life should not be judged by the sports car you drive, but there seems to be something more challenging about finding true sources for understanding the world.  We will each approach the world with different perspectives and experiences, and we will each appropriate separate values to ideas and topics.  I do not think we can honestly understand the world if we have not first mastered honestly knowing ourselves, and then it is a constant practice to source out the good and bad information.  I am not saying, and I don’t think that Saunders would either, that we should just look for positive information about the world, but that we should search for objective information about things that will actually matter and have meaningful impacts in the world.  With the avalanche of information on the internet, it is easy to get lost among fake news stories that do not represent the true world we live in.  At the same time we can all have so many unique niche interests that we investigate and learn about, and each of these interests build new experiences and perspectives through which we can understand the world.
I think that Sanders in reaction to my writing would say that the first step to fulfilling our important task on this planet is to understand ourselves, including our perspective and how our experiences have shaped our perspectives.  Next, Sanders would argue that we absorb as many other perspectives as possible, to help us begin to view the world in a new and meaningful way. This would involve vigorous research on our part to sift through the nonsense and gossip.