Monday, July 10, 2006

The Anechoic Effect Explained

In a new book from Oxford University Press, The Elephant in the Room, Rutgers sociologist Eviatar Zerubavel explains more broadly what I've been noticing for quite some time in medicine, something I've called the anechoic effect. Why is it that folks can behave like such miscreants and everyone turns a blind eye?

Turns out there is a real science, and tons of data, behind the mechanism for this phenomenon of "conspiracies of silence." I plan to read the whole book, having just read reviews and excerpts so far. But I want to bring it, in the meantime, to the blog readership's attention.

In the book notes, the author (or his editor) notes that, unlike the parable of the Emperor's New Clothes, "the denial of social realities--whether incest, alcoholism, corruption, or even genocide--is no fairy tale." Further, "the longer we ignore 'elephants,' the larger they loom in our minds, as each avoidance triggers an even greater spiral of denial."

Sound familiar?

In a useful explanation of his approach to selective memory, presented to the University of Virginia several months ago, Zerubavel talks about the "sociology of attention," in which the intensely social activities of remember things, "telling on" one's colleagues, and whistle-blowing (another, even more fraught form of "telling on") all become susceptible to "denial and oblivion."

Do things like this happen in healthcare? Let us know what you think.


Anonymous said...

In my undergraduate program I had a class taught by the sales manager of a drug wholesaler. One of the many important ideas we were taught was that a salesperson believes what they are saying at the time they are saying it, no matter how outrageous the statement. From the salesperson's perspective they are not telling a lie and this truth may change during a conversation or with the salesperson's new job or product.

This sales concept permeates medicine. Big pharma's business practices reach into every corner of not only medicine but also research. A second concept is, a salesperson always wishes to win and will escalate a situation to achieve their goal. One measure of success is money.

Combining the above it becomes reasonable to skew the research because we are providing a new medical cure, even if it has no merit or is harmful, because we believe in the product, we also win and will continue our funding.

The drug rep believes because they are paid to believe and this is all they know. Drug reps are salespeople. Period.

Doctors fall into this trap due to exposure. They speak of patient care, but you find long waits and a surly staff. Prescriptions are written based on the drug reps short sale pitch instead of looking at the drug abstract. A doctor will never admit being influenced by food, event tickets, or speaking fees. They are after all selling good health and above average care.

Studies are showing a strong continuity in standard of care for a community that varies by geographic location. The open secret is that if Joe gives all of his patients a statin I will give mine a statin plus a BP med because I am a better doctor.

At the corporate level we can justify anything because we a preserving share holder equity or for a nonprofit better physical plant, not necessarily better service. We are selling our corporate vision even if our actions do not follow out public statements. United Health Care comes to mind.

This leaves patients like myself trying to sort out a great deal of complicated information given in a short period of time during the typical office visit. Questions are rebuffed with: If you were an MD you would understand. After one long sales pitch I asked about the numbers needed to treat where the doctor promptly got up and left the room.

Medicine needs to move out of it's selling mode and remember that: Facts are the enemy of truth.

Steve Lucas

Anonymous said...

This might add to the debate:

Complicity theory.