A Short Drive with Healthy Skepticism’s Dr. Peter Mansfield
Late on Wednesday afternoon, a picture perfect summer day in New York, I found myself waiting in the baggage claim area of La Guardia airport for Flight 360 from Chicago. I was there to meet Dr. Peter Mansfield of Australia’s Healthy Skeptism and to take him to the Wales Hotel in Manhattan. It would be a brief opportunity to talk to one of the world’s leading critics of pharmaceutical promotion.
Professor Mansfield had told me to look up his picture on Google Images and there was doubt it was him when he walked into the thicket of limousine drivers surrounding the baggage claim area. I soon learned that he was in the 7th week of a 9 week trip around the world that included 23 major metropolitan areas. No wonder he looked a bit tired. He had travelled in Europe (mentioning Switzerland, Italy, Germany, Spain and England), had come back to the US, was now in New York to speak at Mount Sinai Medical School, would then travel to San Francisco, Seattle, Sydney and Hobart before returning home sometime after June 25th. It seemed a Herculean task and he had been doing this for 25 years. [Medicamentos Madrid has a copy of his slide show presentation posted]
On our way to the car, Dr. Mansfield spoke about the Healthy Skepticism website which has links to 14,001 references on pharmaceuticals. The site is very thorough and relatively easy to navigate. Healthy Skepticism also offers a free monthly newsletter and a Fora where members can post messages.
As we drove out of the airport he told me he has been working on a reform proposal to address the problems of misleading drug advertising. Among the elements of this proposal were to 1. Increase regulation of drug promotion; 2. Improve medical decision making; 3. Redesign the incentives for doctors; and 4. Redesign the incentives for drug companies. He spoke of the need for doctors to be educated about their own biases. “Doctor’s don’t like to think that they are subject to bias,” he told me. And he then made a point of his own interest in hearing criticisms of their proposals; “that’s the only way they will get better.”
How did he propose to bring about these reforms? He leaned over conspiratorially and said: “With laughter! You can get people to see things with laughter that you cannot do in other ways.” Then, more seriously, he compared political processes to earthquakes. For a long time steam builds up until finally something dramatic happens and there is a break. This is the time when you need to present the politicians with a well-worked out plan. How could one build up such steam? Who were the natural constituencies of the reform plan? “Well, anyone who thinks that now – or in the future – they might get sick. [A smile] And all the employees of the pharmaceutical industry, except a very small group at the top, will want to see that they are doing the right thing. Reform is in their interest.”
I had wanted to ask if he really felt that misleading promotion was the main problem with the pharmaceutical industry, but by this time the New York City traffic had taken us near Mount Sinai Medical School and the Wales Hotel. He had to be up the next morning for an 8AM lecture and so it seemed time to end. As we parted he told me that his home town of Wilunga, where he worked as a GP, had only three thousand inhabitants “and would fit easily into one of these large buildings here.” Unloading his luggage we shared a bit about our families. Doctor Mansfield and his wife had three daughters: twins aged 18 and a 16 year old. “When I was in Sweden,” he told me, “and I told them I had 3 daughters in 18 months they asked, With how many women?” We laughed and said good-bye, exchanging cards and ideas. I mused on the idea of travelling for 9 weeks to 23 cities, entrusting yourself to complete strangers (as I was to him), getting to know them briefly and then moving on. This is political organizing or – as Dr. Mansfield might put it – building up steam.
Healthy Skepticism recently sent out the following email concerning Dr. Mansfield’s trip. It provides some of his more formal thoughts about the issues in this posting. Matt Anderson
Director’s presentations in 2008
So far this year, Healthy Skepticism director Peter Mansfield has given 34 presentations and had many more conversations about drug promotion in 23 cities in Europe, Nth America and Australasia. One conversation was with Matthew Anderson who posted an entry about it on the Social Medicine blog. http://www.socialmedicine.org/2008/06/13/big-pharma/a-short-drive-with-healthy-skepticisms-dr-peter-mansfield/
Peter has concluded: “Whilst the details differ from place to place, the important issues are the same. Everywhere there seems to be 5 stages we need to help people to go through to help us achieve our aim of reducing harm from misleading drug promotion:
1. Becoming aware that misleading drug promotion is an important problem.
We can help by telling people about avoidable drug disasters caused by misleading promotion.
2. Understanding the problem.
Some people think the main problem is bad people intentionally causing harm. I think the main problem is unintended bias amongst good people in bad systems. People are more vulnerable to misleading promotion if they are overconfident about their ability to resist it. If people feel accused of intentionally causing harm they will respond with denial and reactance. To win support we need to help people accept that all good people, including themselves, have human strengths including potential for compassion, imagination and humour etc but also human weaknesses including vulnerability to misleading persuasion regardless of intelligence, education and good intentions etc.
3. Deciding what changes are needed.
If the problem was only bad people then the solution would be easy: replace them. If part of the problem is good people in bad systems then we must change the systems. Doing so would solve the bad people problem also. Many people are working on understanding the details of the problems but few people are working on developing solutions. Around the world there has been high levels of agreement with the Healthy Skepticism reform agenda for system changes: improve regulation, improve incentive systems, improve treatment decision-making.
4. Becoming optimistic.
Many people are pessimistic that the changes needed are achievable. Such pessimism can be self-fulfilling by reducing willingness to act in ways that could be effective or provide opportunities for learning. Some people can be helped to become more optimistic by being told about the experiences of people I met in Berlin and Belfast. In those cities change was like an earthquake – it seemed that nothing was happening but forces were building up that gradually reached a tipping point releasing sudden dramatic changes that surprised all but the most optimistic.
5. Deciding to work alone or together.
Inevitably many of the leaders working on drug promotion issues are independent thinkers who do not naturally work together. It is useful to consider:
“If you want to go fast, go alone. If you want to go far, go together.”
- African proverb”
If you want to go together, please get more involved in Healthy Skepticism Inc. To do that – please contact Robyn Clothier robyn@healthyskepticism.org
I’m a member of Peter Mansfield’s “Healty Skepticism”, and I understand that I am one of only 4 members of this organization that is an ex-big pharma sales representative.