Why People Overestimate Medicine's Value: The File Drawer Problem in Lay Health Communication

Abstract

*Objectives*. People often hold unduly positive expectations about theoutcomes of medical treatment. The objective to test the followingexplanation: People who have a positive outcome tend to tell more peopleabout their disease/treatment than people with poor or average outcomes.Akin to the file drawer problem in science, this systematically andpositively distorts the information available to others. *Design. *Acomparison of average health outcomes in clinical trials with averageoutcomes in online health product reviews. *Methods*. If people with goodoutcomes are more inclined to tell other people, then they should also bemore inclined to write online medical product reviews. Therefore averageoutcomes in these reviews should be more positive than those found in RCTs.Data on duration of treatment and outcome (weight or cholesterol change)was extracted from user-generated health product reviews on Amazon.com andcompared to RCT data for the same treatments using ANOVA. The sample included1,675 reviews of cholesterol reduction (Benecol, CholestOff) and weightloss (Orlistat) treatments and the primary outcomes were Cholesterol change(Bencol and CholestOff) or weight change (Orlistat). *Results*. In threeindependent tests, average outcomes reported in reviews were substantiallymore positive that outcomes reported in the medical literature (η2: .01 to.06; p: .04 to .001). For example, average cholesterol change following useof Benecol is - 14mg/dl in RCTs and -45mg/dl in online reviews.*Conclusions*. People with good outcomes are more inclined to shareinformation and this distorts the information available to others. Patientswho select treatments based on word of mouth, electronic or otherwise, arelikely to have unduly positive expectations.

Copy-the-majority of instances or individuals? Two approaches to the majority and their consequences for conformist decision-making

“…An analogous dynamic has been noticed for medical treatments. Studying reviews of cholesterol and weight loss treatments on the website amazon.com, de Barra [43] reported that "people who have a positive outcome tend to tell more people about their disease/treatment than people with poor or average outcomes”. If information A is “cholesterol treatment X is good” and information B is “cholesterol treatment X is bad”, even if the majority of individuals did not experience positive effects, information A will be more likely to be shared, and may appear to be more common.…”