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Healthy narratives?

In medical market research we see that most physicians are not early adopters, preferring to wait for their colleagues to adopt new medicines and practices before doing so themselves. There are good reasons for not diving in. But the power that established narrative has over our lazy, risk averse brains should not be one of them.

I hear on the BBC this morning that a new study (http://goo.gl/5yXP3V), published in the British Journal of Sports Medicine suggests that exercise doesn't have any benefit if you're trying to lose weight (that's not to say don't exercise, it is - fairly obviously - still essential for our overall health and well-being).

This idea has been doing the rounds for a few years, most notably with the High Impact Training approach (http://goo.gl/XOxSE5). The basic contention of the article is that whilst exercise burns calories, the established model of a regular 30 minutes per day / regular gym visits encourages us towards compensatory eating. We don't realise it but there are strong non-conscious psychological urges that push us towards this. The authors of this particular study contend that the food and drinks industry must shoulder some of the blame for exacerbating the trend, by associating 'active lifestyle' messages with their sugar- and carb- heavy brands, advocating an "eat what you like + exercise + eat what you like" approach to life.

Whatever the merits of the emerging evidence, it has a mountain to climb when it comes to getting a foothold. The prevailing narrative that a calorie controlled diet + exercise will lead to weight loss has become accepted wisdom.  All new evidence must not only withstand the proper peer-reviewed tests, it then needs to batter at the door of established narrative.

Rationality is lazy (Kahneman's "System 2") and our brain very often doesn't fancy the challenge of assimilating new information and adjusting to it. We are also 'risk averse' - we revert to safe positions (conventional wisdom) and are sceptical of emerging evidence. There are good evolutionary reasons why humans adopt these default tendencies, but nevertheless they prevent us moving on in situations like this.

It may be that the new science in this case is not all it currently claims to be. That's fine, I'm not wishing to advocate it necessarily, instead using it to make the point that powerfully reinforced narrative can, over time, become conventional wisdom, which is then very difficulty for evidence (of any quality) to usurp.

It is not all bad news. If we understand why we can be resistant to new evidence, even when it looks convincing, then we can 'reverse' it into research and marketing strategies that accept these inevitable heuristics. Strategies that seek to reassure(allow for risk aversion) rather than convince (because our lazy brains probably won't bother to investigate) may well be the most effective in healthcare and other science based sectors.

Look forward to discussing this theme further at the BHBIA Conference May 11th/12th "Numbers vs Narrative"!

23rd April 2015

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