Fact or Anecdote?

How the Religious Right use Anecdotes to undermine scientific argument.

When it comes to debating issues there are two broad strategies you can employ.

  1. Use facts to prove your case.
  2. Tell a good story.

An anecdote is simply a good story, usually one that is personalised to make it highly emotional.  In many cases those who use anecdotes present them as pseudo-facts and call them by scientific sounding terms such as “anecdotal evidence”.

The human brain is programmed to relate to stories.  Behavioural economists have demonstrated how humans default to “type 1” and struggle with the “type 2” thinking that is required to correctly assess complex quantitative data (Thinking, Fast & Slow.  Daniel Kahneman, 2011).

Anecdotes play to our Type 1 thinking.  We can place ourselves in the story and empathise with a situation far more easily than we can digest a plethora of bland numbers.  Politicians have long known this.  Former US Speaker of the House, Tip O’Neill, famously told us that “all politics is local”.

Many will remember how John McCain and Sarah Palin latched onto “Joe the Plumber” as the poster boy for Republican Party credentials to serve small business.  Tony Blair led the British Labour Party to power after years in the wilderness by targeting the middle ground swing voter that they called “Mondeo Man” after the Ford car so favoured by sales teams in the UK.

Many technical professionals argue with hard facts, detailed statistics, “boring” numbers.  They bog their audience (and interviewers) down in Type 2 diatribes.  If they are in an argument with an anecdotist they will lose.  One of my favourite lines in debate, delivered by an Anecdotist to a Statistician;

Ah sure you can prove anything with statistics, I want to talk about the facts.”

The very best technical experts know that they must convert their cold, hard, impersonal statistics into a warm, engaging, human story.  This is the realm of the “Insights” professional.  It is something I call #tainment such as teachers putting the fun in teaching and making it Edutainment!

 

What has all this to do with Religion?

One of the primary roles of the religious community is to take a long (very long) view of the impacts that changes have on society, societal mores, community health and general spiritual wellbeing.  This position serves a vital role in counterbalancing short term profit motivated interests.  The various churches will always drag their heels on rapid change.  Experience has shown that it takes many years to understand the full impact of a change, and their preference is to delay and postpone rather than move and regret.

HPV vaccination is a perfect illustration of this position, as it is an area fraught with ethical issues.  These are neatly summed up in this quote from Patrick Hayes MD, a Catholic Doctor.  It was originally published in Health magazine, and is also available online here:  http://www.catholic.org/news/health/story.php?id=51576

Dr. Hayes says “ …as HPV is a sexually transmitted disease (STD), the success of a ‘medicine’ that appears to remove the consequences of sin, by preventing genital warts and cervical cancer in persons who have one or multiple sexual partners who have had multiple sexual partners, leaves persons of faith and chastity questioning the motives and wisdom of governments, pharmaceutical companies and doctors.”

He also says “The vaccination should not be mandated, because in the absence of sexual contact, unvaccinated students pose no threat to others. “

Overall Dr. Hayes writes a fair and balanced piece.  The latter statement is straight out of the Catholic playbook.  Let’s face it, in the absence of sexual contact girls will never get pregnant.  This is the Catholic position on the use of contraception!

The Irish Government introduced a vaccination programme for schoolgirls from age 12/13 (first year in secondary school) using Gardasil, the HPV vaccine developed by Merck.

We are now seeing the anecdotal machine getting into gear.  Ireland is a backwater, but an important one for religious issues.  If Ireland takes a backward step on HPV vaccination this sets a precedent for pressure groups in the USA who are opposed to vaccination.  They are prepared to invest money and resources into Ireland to see such an outcome.

Some of these groups are opposed on religious grounds, others are opposed to “big government” setting up mandatory healthcare.  They all prey on the concerns of parents for the health of their children.

Their key arguments are:

  1. Here is a girl (anecdotal evidence 1) who became ill or died after receiving the vaccine.  If you give the vaccine to your daughter she will become ill or die.
  2. Pharmaceutical companies know this is a dangerous poison, but they are making big profits on it, so they are covering up the facts (conspiracy theory 1)
  3. Doctors involved in the clinical trials were bribed by the Pharmaceutical company to falsify the results (conspiracy theory 2). Here is a case of such a doctor (anecdotal evidence 2)
  4. We have given the pharmaceutical company all the information and they have ignored it (anecdote 3: the cold hearted corporate machine)
  5. The FDA (local medical approvals board) were fed misinformation on this drug by the pharma company (ergo they are incompetent fools) and certain key officials were given payoffs in the form of money or business trips or jobs (ergo they are corrupt). The bottom line is that you can’t trust government.

Let’s address these arguments one at a time:

  1. Any government sponsored vaccine must pass through a rigorous testing and selection process.  It must go through extensive and detailed clinical trials.  Every drug or vaccine carries side effects and risks.  These are detailed and quantified as part of the trials process.

In statistical terms these negative outcomes represent a tiny fraction of the population.  The benefits of the vaccine far outweighs any negative outcomes.  However, if you are the parent of one of the girls who dies then the statistics are cold comfort.

When Gardasil was rolled out in Germany two girls in the first vaccinated cohort died as a result of the drug.  That is 2 in 1.5 million, which represents 0.0001%.  The incidence is miniscule in statistical terms and devastating in personal terms to the families involved.

Yes there are cases where girls became ill due to the vaccine.  They tend to fall within the limits established by the clinical trial.

There are also many cases where girls become ill shortly after they receive the vaccine.   The anecdotists seize on these cases to boost the fear factor in relation to the drug.  Just because condition B followed condition A does not prove causality.  Anti-vaxxers don’t care about such niceties.  They don’t need to prove their points.  They simply have to throw doubt upon the opposite position.  This is classic “fear marketing”.

I am not a fan of fear marketing techniques.  It is most effective with people who worry the most, and with those who don’t have the education or intelligence to carry out proper research.  Fear marketing preys on the weak and that is not nice.  It is not Christian.

  1. The conspiracy theory that the Pharma companies are knowingly selling poison for profit.  There have been cases where pharma companies have behaved dreadfully, so I won’t apologise for them.  The Tamiflu scandal by Roche pharma is a perfect example, where they withheld information.  The drug was not a poison, it was just useless.  Merck with Vioxx, Bristol Myers Squibb with Abilify and GSK with Avandia.  They may not be selling poison, but they are manipulating the data for profit.  That is despicable.
  1. Doctors manipulating data? Yes, the evidence is there.  It happens.  Doctors, it seems, are no more immune to corruption than any other group in society.  Some manipulate results because of poor research practice, where they screen out data that does not meet with their preconceptions.  Others do it for cash.

I think we need to look at how we recruit and train doctors.  At present, in Ireland, medical schools select medical students on academic excellence.  If we selected on empathy and care for others I suspect we might attract fewer high wealth seeking individuals.

  1. The cold hearted corporation anecdote also holds true. We have all seen Erin Brokovich!  Look at the Ford Pinto scandal, where the bean counters preferred to pay death and injury damages rather than recall and fix faulty cars.  Such a cavalier attitude to the lives of humans represents a real concern about the kind of people who lead large companies.  The corporate ladder appears to reward executives who are amoral and unempathic.
  1. Incompetence and/or corruption in medical approvals officials.  Given point 2, that pharma companies manipulate the clinical trials data, it is no surprise that government officials have been caught out.  They have been lied to, repeatedly.  Also, like the doctors, they are not immune from corruption.  There are enough smoking guns out there to fill an arsenal.

So when you look holistically at the arguments put out by anti-vaxxers there appears to be more than enough smoke to suggest a fire.  When you put all the pieces of disinformation together you come up with a pretty compelling conspiracy theory.

The only way to debunk the conspiracy theory is to tear it apart, step by step, using cold hard statistics.  No audience is going to hang around for that.

The upshot of all of this is that the medical and pharmaceutical industries are personally and collectively responsible for the mess they have made.  In modern Ireland we have outbreaks of Measles and Mumps in teenagers who were not vaccinated back when the MMR was blamed for Autism.  Study after study has disproved any link existed.  The doctor who originally made the link was found guilty of falsifying his results.   https://en.wikipedia.org/wiki/Andrew_Wakefield  And still the story continues to spin and be believed.  Now we see exactly the same arguments being rolled out in relation to HPV vaccines.

When Markets go Dark

Darkside

Traditional marketing theory holds that there are three broad strategies for positioning a product.  You can be the best, you can be the cheapest, or you can serve a specific niche.

It is most simple to communicate that you are the best or the cheapest.  It is more difficult to communicate niche benefits.  One great boon of the arrival of the internet was to support niche communications.  Using the internet you can target communications at tiny market segments and still succeed.  As a result we get the “long tailed comet” and the weakening of mass market simplification.  We don’t all have to settle for a white sliced loaf simply because it serves the broadest audience.  You can get your loaf of yeast free pumpkin seed bread made with stone ground flour from a mill operated by orphan refugees.

What is interesting about Dark Markets is that this niche power is removed.  Tobacco is the most dark market we have.  Some nations are very dark, Australia, Canada, Ireland and England seem to be in a competition to win the race to be the darkest tobacco market.  In Ireland the product is no longer visible in-store.  The packs are hidden behind closed doors, and no advertising, promotion or communication of any sort is permitted to the end consumer – other than the price list.

Absent any communication it is impossible to convey the benefits of niche products.  As a result people select using simplified heuristics.  They can see the price.  So it is either high price or low price.  Highest price must be the most premium product and lowest price is assumed to be best value.  Consumers assume that lower price products will be of inferior quality, and in the case of tobacco they will be less “healthy” than the premium price products.  It is interesting that the biggest markets for low price brands, and for counterfeit brands, are in the “full strength” tobacco products.

Profit margins on low price products are derisory.  It is in the interest of the manufacturers to keep as much of the business as possible up at the premium end.

So what?

Other markets are going dark.  Pharmaceuticals are partially there, Alcohol is being targeted, Baby Milk Formula, Childrens Cereals.  Many products run the risk of following tobacco down the path to the dark side.  What lessons can you learn from Tobacco?

1.  Stop fighting for share.

If you treat a dark market the way you treat an overt market, and fight for market share, you will lead a race to the bottom on price, and drive value out of the market.  The major players in the market have to move away from using share points to reward sales teams.  Focus on profitability measures.

2.  Build premium positions.

Forget the middle market.  Devote your resources now to building strong premium positions that are simple, clear and relevant in the minds of your consumers.  Don’t waste money building brand positions for marginally profitable lines.  Be patient!  Take your time to build your premium position.  You will come under relentless pressure from sales to use sales promotions and discounts to push share.  You have to fight that.  A premium brand should never be on sale.

3.  Cheap must have a compromise.

If one player is building a fighter/Tiger brand, you need to communicate to your consumers why Premium is different to Value.  Why is cheap also nasty?  You must convey this effectively before the market goes dark, or the consumer will simply buy on price.  But you also need to be careful not to damage the category.  If cheap vodka is bad for your health, it must also be clear that premium vodka is at least health neutral (ceteris paribus)

4.  Motivate stakeholders early.

Get the retailers to buy in on premium.  Make sure they understand that it is about CASH margin, not percentage margin.  So what if you get 15% on a $10 bottle of Vladiawfull vodka.  It is far better to get a tight margin on a €60 bottle of Grey Goose.  Also, get them to fight for light.  Make it clear to them what the negative impact of a dark market means to their business.  Organise them into lobby groups.  Help them to advocate their positions with  grass roots political representatives.

5.  Build a network of ambassadors.

Find the people who like your product now and recruit them for the long haul.  Not barmen or shop staff.  They have to have longevity, so they need to be business owners.  Get long term buy in for your brands now, and it will pay back handsomely when the market goes dark.  Bring these people together, make a community where they can help each other and help your brands.  The market may be dark, but you can have online buzz as members plan their next outing of the eg John Player Amateur Golf Classic.