1. Do you have heavy menstrual flow?
2. Do you dread the first days of your period?
3. Do you have to organize your physical, leisure and daily activities around it?
Do you realize this survey is persuading you?
4. Does your bleeding soak through one or more pads or tampons every hour for several hours?
Do you know that medical researchers define heavy flow as ” . . . flow of more than . . . 16 soaked sanitary products per menstrual period?”
Do you still have heavy menstrual flow?
If you do, then this survey may have persuaded you to buy a drug you don’t need.
READ THIS: I am not a medical expert and certainly have no credential in women’s health. You are in charge of your body and I’m not making any medical recommendations. Read. Think. Gather more information. Think! For yourself! Okay?
Now, our key point: it is easy to persuade people on health and safety behaviors and you need to understand the difference between persuasion and education.
This survey is a new example of an old idea that is now called push surveying. You are asked to provide your answers to a survey as part of a poll or research study or as a scientific measure. And, the questions on the survey seem to be objective, unbiased, and straightforward. However, if you read them more closely, you realize that the questions are worded in a way that pushes you toward a particular attitude, belief, or behavior.
For example, I can make you feel a lot more religious by wording questions on your religious behavior in a way that makes you say “Yes” a lot as in:
1. Do you ever attend religious services?
2. Have you taken any religious training?
3. Have you ever made a contribution to a religious group?
Even the most ardent atheist will have to agree with questions like this and that agreement in this moment makes you more vulnerable to the push. I move you just through careful wording of a “scientific” survey.
The persuasion force behind this play is self perception theory as developed by Daryl Bem in the 1970s. Bem argues that we observe our own behavior just like when we are watching a stranger. We then draw inferences about ourselves just as we do with strangers. If we see a stranger hold a door open for someone, we can infer that person is “polite.” When we open a door for someone, we observe that action and infer, “Gee, I’m polite.”
Salancik and Conway used this reasoning to conduct a series of lab and field experiments that manipulated self perception of religious beliefs (guess where I got my religion push survey above?). Lo and behold, they found that these push surveys could indeed move people’s immediate attitudes, either more or less religious depending upon the push, and that people would behave consistently with that self perceived attitude.
So, in our current example, you take the survey on periods and you find yourself marking a lot of yes answers. You then observe your attitude and conclude, “Gee, I need this pill!”
We can realize that this tactic is a Peripheral Route, low WATT, Cue-based play. You are not a high WATT laser beam here, looking for all the available facts, evidence, and reasoning on periods, then carefully considering the information, elaborating on it with that Long Conversation in the Head to form a Central Route change that is persistent, resistant, and predictive. Nope. You just observe all those “Yes” answers, click on the coupon link or email registration, and they’ll get back to you right away.
Now, if you’re smart you realize that it is easier to push on issues that are abstract and not concrete. So, how can these pharma wizards push women on something as concrete as a period? Easy. Never use numbers. Always use words.
Realize the problem does exist. Some women experience way out of range menstrual periods and if you just count, science appears to indicate a quantitative standard: 16 soaked sanitary products in one period. By this standard fewer than 25% (1 in 4, right?) of women have “heavy flow” or, more technically, menorrhagia, and most of that is going to be among perimenopausal women, not younger women.
So, technically, we’ve got a drug that is most useful to older women and less so among younger women, but if you look at the ads, the models are not that older demographic. And, if you read the print testimonials for a particular drug you note the ages of the women are all under 50 with a range from 43 to 26. And, none of these testimonials discuss that explicit standard of 16 products in one period. They instead feature subjective terms regarding cleanliness, motivation, and attractiveness. And, of course, there’s that push survey.
Now, notice what has happened. We’ve gone from a fairly straightforward, measurable standard – remember the number 16 – and blended in elements that are considerably less straightforward and measurable – attractiveness, motivation, feelings of cleanliness. We can make a much larger group of women start thinking, “Hey, I need this pill.” That’s great for business in the same way that guys under 60 or 50 or 40 with no serious underlying medical condition are using that little blue pill for their “erectile dysfunction.”
So, from just this innocent looking survey, I’ve dragged you through push surveys, self perception theory, and a quick WAC analysis with the ELM. Who knew it was so busy? Still waters run deep you know or as my Rule states:
More Is the Enemy of Less
I could go on quite a bit with this. What about the ethics of push surveys to push pills? What about tempting women with words when numbers are useful? Didn’t hormone replacement therapy start something like this? Hey, I didn’t tell you about all the controversy with Bem’s self perception theory and the battles with dissonance theorists. Professors were literally fighting each other at professional conferences over self perception versus dissonance. Sigh. So much to say, so little time to say it.
But, the pharma guys are getting their groove back.
Technical Addendum.
1. Push is a passe and nowadays if we are Tragically Hip and Postmodern Cool, we should call it Nudge, rather than Push, although Nudge’s probably not going to be as Cool after the 2010 midterm elections, but that’s what makes it Tragically Hip – after November 2010 you’ll likely have a beautiful word killed by ugly conservatives. That’s the problem when you tie your political philosophy to your work; elections, not science, determine your success.
2. Bem’s work goes back to the early 1970s. Yes, people were alive then and doing good research that did not appear on the Internet because the Internet didn’t exist then, but smart people did. We used paper to write words and tables and graphs, then collected those papers into journals and books. Wow. You can go to a museum called The Library and see these artifacts.
3. It appears that Lysteda works (go to Page 6 on the slide show). Look at this graph.
That’s an almost 50% reduction. A woman would need half as many tampons or napkins as usual. That is a noticeable and practical improvement. Yet, I’d caution, caution. While we see this effect size, I’d raise the specter of hormone replacement therapy. No one did a good, long term study on the effects of HRT and we got a very nasty surprise with breast cancer. There are no long term (10 or 20 year follow up) studies with Lysteda, so, again, if you are cautious, you might want to be cautious here.
